Systematic review and meta-analysis.
To evaluate outcomes of surgical treatment for nephrolithiasis in individuals with spinal cord injury (SCI).
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.
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.
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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Welk B, Fuller A, Razvi H, Denstedt J. Renal stone disease in spinal-cord–injured patients. J Endourol. 2012;26:954–9. https://doi.org/10.1089/end.2012.0063.
Ku JH, Jung TY, Lee JK, Park WH, Shim HB. Risk factors for urinary stone formation in men with spinal cord injury: a 17-year follow-up study. BJU Int. 2006;97:790–3. https://doi.org/10.1111/j.1464-410X.2006.05991.x.
Burr RG, Chem C, Nuseibeh I. Creatinine, calcium, citrate and acid-base in spinal cord injured patients. Spinal Cord. 1993;31:742–50. https://doi.org/10.1038/sc.1993.116.
Nabbout P, Slobodov G, Culkin DJ. Surgical management of urolithiasis in spinal cord injury patients. Curr Urol Rep. 2014;15:408. https://doi.org/10.1007/s11934-014-0408-3.
Ramsey S, McIlhenny C. Evidence-based management of upper tract urolithiasis in the spinal cord-injured patient. Spinal Cord. 2011;49:948–54. https://doi.org/10.1038/sc.2011.50.
Moher D, Liberati A, Tetzlaff J, Altman DG, Group TP. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLOS Med. 2009;6:e1000097. https://doi.org/10.1371/journal.pmed.1000097.
Higgins JPT, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, et al. Cochrane Handbook for Systematic Reviews of Interventions. John Wiley & Sons; 2019.
Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD, et al. The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg. 2009;250:187–96. https://doi.org/10.1097/SLA.0b013e3181b13ca2.
Slim K, Nini E, Forestier D, Kwiatkowski F, Panis Y, Chipponi J. Methodological index for non-randomized studies (MINORS): development and validation of a new instrument. ANZ J Surg. 2003;73:712–6. https://doi.org/10.1046/j.1445-2197.2003.02748.x.
Bølling Hansen R, Biering-Sørensen F, Kvist Kristensen J. Urinary calculi following traumatic spinal cord injury. Scand J Urol Nephrol. 2007;41:115–9. https://doi.org/10.1080/00365590600991383.
Elmelund M, Oturai PS, Toson B, Biering-Sørensen F. Forty-five-year follow-up on the renal function after spinal cord injury. Spinal Cord. 2016;54:445–51. https://doi.org/10.1038/sc.2015.242.
Wang H-HS, Wiener JS, Ferrandino MN, Lipkin ME, Routh JC. Complications of surgical management of upper tract Calculi in spina Bifida patients: analysis of nationwide data. J Urol. 2015;193:1270–4. https://doi.org/10.1016/j.juro.2014.09.095.
Goumas-Kartalas I, Montanari E. Percutaneous nephrolithotomy in patients with spinal deformities. J Endourol. 2010;24:1081–9. https://doi.org/10.1089/end.2010.0095.
Christman MS, Kalmus A, Casale P. Morbidity and efficacy of ureteroscopic stone treatment in patients with neurogenic bladder. J Urol. 2013;190:1479–83. https://doi.org/10.1016/j.juro.2013.02.101.
Siroky MB. Pathogenesis of bacteriuria and infection in the spinal cord injured patient. Am J Med. 2002;113:67–79. https://doi.org/10.1016/S0002-9343(02)01061-6.
Storme O, Tirán Saucedo J, Garcia-Mora A, Dehesa-Dávila M, Naber KG. Risk factors and predisposing conditions for urinary tract infection. Ther Adv Urol. 2019;11:1756287218814382. https://doi.org/10.1177/1756287218814382.
Burr RG. Urinary calculi composition in patients with spinal cord lesions. Arch Phys Med Rehabil. 1978;59:84–8.
Gnessin E, Mandeville JA, Handa SE, Lingeman JE. Changing composition of renal calculi in patients with musculoskeletal anomalies. J Endourol. 2011;25:1519–23. https://doi.org/10.1089/end.2010.0698.
Knoll T, Schubert AB, Fahlenkamp D, Leusmann DB, Wendt-Nordahl G, Schubert G. Urolithiasis through the ages: data on more than 200,000 urinary stone analyses. J Urol. 2011;185:1304–11. https://doi.org/10.1016/j.juro.2010.11.073.
Zhang D, Li S, Zhang Z, Li N, Yuan X, Jia Z, et al. Urinary stone composition analysis and clinical characterization of 1520 patients in central China. Sci Rep. 2021;11:6467. https://doi.org/10.1038/s41598-021-85723-3.
Dallera JE, Chandhoke PS Epidemiology and Incidence of Stone Disease. In: Stoller ML, Meng MV, editors. Urin. Stone Dis. Pract. Guide Med. Surg. Manag., Totowa, NJ: Humana Press; 2007, p. 27–34. https://doi.org/10.1007/978-1-59259-972-1_2.
Kreydin EI, Eisner BH. Risk factors for sepsis after percutaneous renal stone surgery. Nat Rev Urol. 2013;10:598–605. https://doi.org/10.1038/nrurol.2013.183.
Motamedinia P, Korets R, Badalato G, Gupta M. Perioperative cultures and the role of antibiotics during stone surgery. Transl Androl Urol. 2014;3:297–301. https://doi.org/10.3978/j.issn.2223-4683.2014.07.01.
Terry RS, Preminger GM. Metabolic evaluation and medical management of staghorn calculi. Asian J Urol. 2020;7:122–9. https://doi.org/10.1016/j.ajur.2019.12.007.
Miller NL, Lingeman JE. Management of kidney stones. BMJ. 2007;334:468–72. https://doi.org/10.1136/bmj.39113.480185.80.
Welk B, Liu K, Shariff SZ. The use of urologic investigations among patients with traumatic spinal cord injuries. Res Rep Urol. 2016;8:27–34. https://doi.org/10.2147/RRU.S99840.
de Souza Melo PA, Vicentini FC, Beraldi AA, Hisano M, Murta CB, de Almeida Claro JF. Outcomes of more than 1000 percutaneous nephrolithotomies and validation of Guy’s stone score. BJU Int. 2018;121:640–6. https://doi.org/10.1111/bju.14129.
Zhong W, Yang B, He F, Wang L, Swami S, Zeng G. Surgical management of urolithiasis in patients after urinary diversion. PLOS ONE. 2014;9:e111371. https://doi.org/10.1371/journal.pone.0111371.
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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