Nabbout P et al, 2014: Surgical management of urolithiasis in spinal cord injury patients.
Nabbout P, Slobodov G, Culkin DJ
University of Oklahoma Health Sciences Center, 920 Stanton L. Young Blvd, WP 3150, Oklahoma City, OK, 73104, USA
Urolithiasis is a common condition in patients with spinal cord injury (SCI). Surgical management of stones in this population is more challenging and associated with lower clearance rates than the general population. The rate of complications - specifically infectious complications - is also high due to the chronic bacterial colonization. Shock wave lithotripsy (SWL) has a low clearance rate of 44-73 %. Percutaneous nephrolithotripsy is indicated for larger nephrolithiasis, but multiple procedures may be required to clear the stones. Ureteroscopy has been associated with low success rates because of difficulty in obtaining ureteral access. Historically, bladder stones were managed with open surgery or SWL. Recently, good results have been reported with the combination of endoscopic and laparoscopic techniques. Surgical management of
urolithiasis in patients with SCI should be performed in high-volume centers in light of the technical challenges and higher rate of perioperative
Curr Urol Rep. 2014 Jun;15(6):408. doi: 10.1007/s11934-014-0408-3.
A number of recommendations are given for treatment of patients with spinal cord injuries (SCI). Given the fact that most of these patients had stones composed of struvite and usually were difficult to treat, one option - not mentioned in the article - is a combination of SWL and percutaneous chemolysis with Renacidin . With such a method also very small residuals can be eliminated and the underlying infection much easier treated in an efficient way.
1. Tiselius HG, Hellgren E, Andersson A, Borrud-Ohlsson A, Eriksson I. Minimally invasive treatment of infection staghorn stones with shock wave lithotripsy and chemolysis.
Scand J Urol Nephrol. 1999 33:286-290.