Abstract
Objectives: To review the precautions to be observed before and during extracorporeal shock wave lithotripsy (ESWL) in spinal cord injury (SCI) patients with a cardiac pacemaker and the safety of bilateral ESWL performed on the same day.
Design: A case report of bilateral ESWL in a SCI patient with a permanent cardiac pacemaker.
Setting: The Regional Spinal Injuries Centre, Southport, the Lithotripsy Unit, the Royal Liverpool University Hospitals NHS Trust, Liverpool, and the Department of Cardiology, Manchester Royal Infirmary, Manchester, UK.
Subject: A 43-year-old male sustained a T-4 fracture and developed paraplegia with a sensory level at T-2. During the post-injury period, he developed episodes of asystole requiring implantation of a dual chamber (DDD) permanent pacemaker. Twenty-one months later, he developed a right ureteric calculus with hydronephrosis. A radio-opaque shadow was seen in the left kidney with no hydronephrosis. During right ureteric stenting, the ureteric stone was pushed into the renal pelvis. 1,500 shock waves were delivered to this stone on the right side, followed by ESWL to the left intra-renal stone with 1250 shock waves.
Results: The patient tolerated ESWL to both kidneys. The pacemaker was reprogrammed to a single chamber ventricular pacing mode at 30 beats per minute with a reduced sensitivity during lithotripsy. There were no untoward cardiac events during or after lithotripsy. The serum creatinine was 45 μmol/l before lithotripsy and 44 μmol/l two weeks after ESWL.
Conclusion: SCI patients with a cardiac pacemaker may be able to undergo extracorporeal shock wave lithotripsy following temporary reprogramming of the pacemaker. Bilateral, simultaneous ESWL is safe in the vast majority of patients provided that there is no risk of simultaneous ureteric obstruction by stone fragments. However, it should be remembered that a decrease in renal function could occur following bilateral ESWL of renal calculi.
Spinal Cord (2001) 39, 286–289.
Similar content being viewed by others
Article PDF
References
Gilgoff IS, Ward SL, Hohn AR . Cardiac pacemaker in high spinal cord injury Archives of Physical Medicine Rehabilitation 1991 72: 601–603
Vaidyanathan S et al. Recurrent bilateral renal calculi in a tetraplegic patient Spinal Cord 1998 36: 454–462
Cooper D, Wilkoff B, Masterson M . Effects of extracorporeal shock wave lithotripsy on cardiac pacemakers and its safety in patients with implanted cardiac pacemakers Pace 1988 11: 1607–1616
Drach GW, Weber C, Donovan JM . Treatment of pacemaker patients with extracorporeal shock wave lithotripsy: experience from two continents J Urology 1990 143: 895–896
Albers DD, Lybrand III FE, Axton JC, Wendelken JR . Shockwave lithotripsy and pacemakers: Experience with 20 cases J Endourology 1995 9: 301–303
Chandhoke PS . Editorial comment J Endourology 1994 8: 399
Cass AS . Renal function after bilateral extracorporeal shockwave lithotripsy J Endourology 1994 8: 395–399
Pienkny AJ, Streem SB . Simultaneous versus staged bilateral extracorporeal shock wave lithotripsy: long-term effect on renal function J Urology 1999 162: 1591–1593
Treglia A, Moscolini M . Irreversible acute renal failure after bilateral extracorporeal shock wave lithotripsy J Nephrology 1999 12: 190–192
Abe H, Nisimura T, Osawa S, Miura T, Oka F . Acute pancreatitis caused by extracorporeal shock wave lithotripsy for bilateral renal pelvic calculi Int J Urology 2000 7: 65–68
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Vaidyanathan, S., Hirst, R., Parsons, K. et al. Bilateral extracorporeal shock wave lithotripsy in a spinal cord injury patient with a cardiac pacemaker. Spinal Cord 39, 286–289 (2001). https://doi.org/10.1038/sj.sc.3101144
Published:
Issue Date:
DOI: https://doi.org/10.1038/sj.sc.3101144
Keywords
This article is cited by
-
Evidence-based management of upper tract urolithiasis in the spinal cord-injured patient
Spinal Cord (2011)
-
Extra corporeal shock wave lithotripsy of calculi located in lower calyx of left kidney in a spinal cord injury patient who has implantation of baclofen pump in the ipsilateral loin
Spinal Cord (2002)