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Sampogna G. et al., 2020: Shock wave lithotripsy for a renal stone in a tetraplegic patient as a trigger for life-threatening posterior reversible encephalopathy syndrome

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Sampogna G, Maltagliati M, Rocco B, Micali S, Montanari E, Spinelli M.
Urology Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, University of Milan, Via della Commenda 15, 20122, Milano, MI, Italy.
Neuro-urology Unit, ASST Grande Ospedale Metropolitano Niguarda, Piazza dell'Ospedale Maggiore 3, 20162 Milano, MI, Italy.
Urology Unit, Ospedale Policlinico e Nuovo Ospedale Civile S. Agostino-Estense, University of Modena and Reggio Emilia, Via Pietro Giardini 1355, 41126 Baggiovara, MO, Italy.

Abstract

Shock wave lithotripsy (SWL) is considered a non-invasive treatment for urinary stones and usually advocated for frail patients with spinal cord injury (SCI). We report a life-threatening complication, called posterior reversible encephalopathy syndrome (PRES), in a tetraplegic person who underwent SWL for a small renal stone. Based on our experience, we recommend performing SWL with caution in SCI patients and in tertiary referral hospitals that can promptly manage similar severe complications.
Urol Case Rep. 2020 Apr 9;31:101204. doi: 10.1016/j.eucr.2020.101204. eCollection 2020 Jul. PMID: 32322524. FREE ARTICLE

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Comments 1

Hans-Göran Tiselius
Hans-Göran Tiselius on Thursday, 10 September 2020 10:30

The authors describe an unusual complication, posterior reversible encephalopathy syndrome (PRES), in a tetraplegic patient treated with SWL for a UPJ-stone in the left kidney. This complication, although reversible, is potentially life threatening and required intensive care. The interpretation was that pain was the factor that induced PRES because of the altered pain perception with dysautonomic crisis. A subsequent RIRS was uneventful.

SWL is an excellent non-invasive treatment modality for stone removal in tetraplegic patients. Most centres probably have little experience of SWL in such patients and this case report clearly demonstrates that great care and attention to post-SWL reactions are of utmost importance. The risk of autonomic dysfunction always should be kept in mind.

Hans-Göran Tiselius

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The authors describe an unusual complication, posterior reversible encephalopathy syndrome (PRES), in a tetraplegic patient treated with SWL for a UPJ-stone in the left kidney. This complication, although reversible, is potentially life threatening and required intensive care. The interpretation was that pain was the factor that induced PRES because of the altered pain perception with dysautonomic crisis. A subsequent RIRS was uneventful. SWL is an excellent non-invasive treatment modality for stone removal in tetraplegic patients. Most centres probably have little experience of SWL in such patients and this case report clearly demonstrates that great care and attention to post-SWL reactions are of utmost importance. The risk of autonomic dysfunction always should be kept in mind. Hans-Göran Tiselius
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Wednesday, 15 January 2025