WCE 2018: Outcomes of Ureteroscopy for Kidney Stone Disease in patients with Spinal Cord Injury

Paris, France (UroToday.com) Recent statistics have elucidated that there is a greater prevalence of kidney stone disease and a larger stone burden in patients with spinal cord injuries (SCI) as compared to the general population. The reason for this can particularly be attributed to physiological and anatomical changes that occur within the patient as a result of SCI. Dr. Sarah Prattely and her team of endourologists at the understood this issue and wished to be the first to determine what the perioperative outcomes were for these patients following ureteroscopy (URS). She informed the audience that, due to the general health and secondary co-morbidities associated with SCI, the prevalence of these stone events in this patient cohort make URS a much more desirable treatment option as compared to a more invasive approach such as percutaneous nephrolithotomy (PCNL). Therefore, their team attempted to determine the effectiveness of URS in patients with SCI compared to the general population. 

In order to test this idea, the researchers completed a retrospective analysis of all SCI patients who underwent URS between 2005 and 2017 at their center. These patients were then compared to a retrospective cohort of non-SCI patients that were treated for stone disease with URS between 2015 and 2017. These data were collected and analyzed by individuals not directly involved in surgery to attempt to eliminate bias. Patients underwent non-contrast CT, ultrasound, or X-ray KUB scans before and after surgery. Stone free status was attributed to patients who were endoscopically stone free or had ≤ 2 mm fragments.

Following the data collection process, 41 procedures were performed in 21 patients with SCI which was compared to 43 procedures in 40 patients for non-SCI. The mean age was 49 years for the SCI cohort and 54 years for the non-SCI cohort. Of the SCI patients, 71% had a cervical cord injury while the remaining 29% had a thoracic injury. A complete, American Spinal Injury Association grade A injury was present in 86% of patients. There were 10 cases (24%) that had Clavien-Dindo grade II complications in the SCI group as compared to 7% from the non-SCI group. Postoperative recurrence occurred in 42% of patients of the SCI cohort while the non-SCI patients only experienced a recurrence rate of 15%. The stone free rate at 12 months was 47% in the SCI group, which was expectedly lower than the 67% stone free rate experienced by the non-SCI patients.

As she neared the end of her presentation, Dr. Prattley wanted to reiterate that patients with SCI had a much lower stone free rate following URS as compared to previously reported numbers for the general public, which are as high as 77-93%. She explained that this was likely due to stone size, impaired fragment clearance, altered physiology, and previous urinary tract reconstruction. She urged her audience that special consideration should be taken at pre-assessment and consideration for higher level of care postoperatively may be indicated. 

Presented by: Sarah Prattley, MD
Authors: Rachel Oliver, Francesca New, Melissa Davies, James Brewin
Affiliation: Salisbury District Hospital, Salisbury, United Kingdom

Written by: Zachary Valley, Department of Urology, University of California-Irvine medical writer for UroToday at the 36th World Congress of Endourology (WCE) and SWL - September 20-23, 2018 Paris, France