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A systematic review of postoperative outcomes of kidney stone surgery and meta-analysis of outcomes of percutaneous nephrolithotomy in individuals with spinal cord injury

Spinal Cord volume 61, pages 469–476 (2023)Cite this article

Subjects

Abstract

Study design

Systematic review and meta-analysis.

Objectives

To evaluate outcomes of surgical treatment for nephrolithiasis in individuals with spinal cord injury (SCI).

Methods

We systematically reviewed the Ovid MEDLINE, Embase, CENTRAL, and Web of Science databases for studies examining outcomes of kidney stone procedures in individuals with SCI. Our primary outcomes were stone-free rate (SFR) and complications as categorized by Clavien-Dindo classification. A meta-analysis of comparative studies was performed to assess differences in SFR and complication rate between individuals with and without SCI following PCNL.

Results

A total of 27 retrospective and observational articles were included. Interventions for kidney stones included PCNL, shockwave lithotripsy (SWL), and ureteroscopy. Pooled SFR in individuals with SCI was 54%, for SWL, 74% for PCNL, and 36% for ureteroscopy. Meta-analyses found that there was higher rate of grades I (OR 9.54; 95% CI, 3.06 to 29.79), II (OR 3.38; 95% CI, 1.85 to 6.18), and III-V (OR 2.38; 95% CI, 1.35 to 4.19) complications in individuals with SCI compared to non-SCI individuals following PCNL. The rate of infectious complications was also higher in individuals with SCI (OR 6.15; 95% CI, 1.86 to 20.39). However, there was no difference in SFR (OR 0.64; 95% CI, 0.15 to 2.64) between groups.

Conclusions

Individuals with SCI are at higher risk of minor, major, and infectious complications following PCNL compared to non-SCI individuals. There was no significant difference between groups in SFR following PCNL, suggesting that PCNL is an effective surgery for kidney stones in individuals with SCI.

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Fig. 1
Fig. 2
Fig. 3: Forest plots comparing complications following percutaneous nephrolithotomy (PCNL) between individuals with and without spinal cord injury (SCI). CI = confidence interval. SCI = spinal cord injury.

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Data availability

All data generated and analyzed in this study can be found within this article and its supplementary files.

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Author information

Authors and Affiliations

  1. Division of Urology, Department of Surgery, McMaster University, Hamilton, ON, Canada

    John Kim, Michael Uy, Jen Hoogenes & Edward D. Matsumoto

  2. Division of General Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada

    Veronica Stewart & Gaurav Talwar

  3. McMaster Institute of Urology, St. Joseph’s Hospital, Hamilton, ON, Canada

    Jen Hoogenes & Edward D. Matsumoto

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Contributions

JK was responsible for designing the review protocol, writing the protocol and report, conducting the search, screening potentially eligible studies, extracting and analyzing data, interpreting results, writing the manuscript, and creating figures and tables. VS was responsible for conducting the search and screening potentially eligible studies, and also contributed to extracting data. GT contributed to designing the review protocol, screening potentially eligible studies, and extracting and analyzing data. MU contributed to designing the review protocol, analyzing the data, and reviewing the manuscript. JH contributed to analyzing the data and reviewing the manuscript. EM contributed to designing the review protocol and reviewing the manuscript.

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Correspondence to John Kim.

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Kim, J., Stewart, V., Talwar, G. et al. A systematic review of postoperative outcomes of kidney stone surgery and meta-analysis of outcomes of percutaneous nephrolithotomy in individuals with spinal cord injury. Spinal Cord 61, 469–476 (2023). https://doi.org/10.1038/s41393-023-00927-w

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