PURPOSE: The management of upper urinary tract stones in spina bifida (SB) patients is challenging but poorly described in the literature.
Our objective was to compare the treatment and related complications of urolithiasis interventions in SB patients to other stone formers using a national database.
METHODS: We retrospectively reviewed Nationwide Inpatient Sample (NIS) to identify admissions for renal and ureteral stones from 1998-2011. We used ICD-9-CM codes to identify urologic interventions [shockwave lithotripsy (SWL), ureteroscopy (URS), percutaneous nephrolithotomy (PCNL), ureteral stent placement] and National Surgical Quality Improvement Program (NSQIP) to identify postoperative complications.
RESULTS: We identified 4,287,529 weighted stone admissions including 12,315 (0.3%) SB patient admissions. Compared with non-SB patients, SB patients with urolithiasis were significantly younger (mean 34 vs 53 years), more likely to have public insurance (72 vs 44%), have renal vs. ureteral calculi (81 vs 58%), and to undergo PCNL (27 vs 8%). After adjusting for age, insurance, comorbidity, treatment year, surgery type, stone location, and hospital factors, SB patients were more likely to have urinary tract infections (OR 2.5), urinary complications (OR 3.1), acute renal failure (OR 1.9), respiratory complications (OR 2.0), pneumonia (OR 1.5), respiratory insufficiency (OR 3.2) prolonged mechanical ventilations (OR 3.2), sepsis (OR 2.7), pulmonary embolism (OR 3.0), cardiac complications (OR 2.4), and bleeding (OR 1.6).
CONCLUSIONS: Compared with non-SB patients, SB patients admitted for urolithiasis were younger, more likely to have renal stones, and to undergo PCNL. Urolithiasis procedures in SB patients were associated with significantly higher risks of in-hospital postoperative complications.
Wang HH, Wiener JS, Ferrandino MN, Lipkin ME1, Routh JC. Are you the author?
Division of Urologic Surgery, Duke University Medical Center, Durham, NC.
Reference: J Urol. 2014 Sep 24. pii: S0022-5347(14)04548-0.