AUA 2013 - Session Highlights: The surgical management of upper tract stone disease among spinal cord injured patients

SAN DIEGO, CA USA ( - It has been well documented in the literature that spinal cord injury (SCI) increases the risk of kidney stones.

In this interesting study, the incidence, management, and outcomes of surgically-treated kidney stones after SCI is described in the province of Ontario, Canada. In addition, Dr. Welk and colleagues also evaluated the impact of the injury level and past history of kidney stones on the occurrence of kidney stones.

auaThey conducted a retrospective, cohort study using linked, population-based health care data from Ontario, Canada. They followed 5 121 patients for a median of 4 years after an incident SCI (occurring between 2002-2011). The primary outcome was surgical intervention for upper-tract kidney stones.

The results of their study showed that in follow-up, 66 patients (1.3%) had 89 episodes of surgically treated kidney stones. Treatments included: ureteroscopy (34%), ureteral stent/percutaneous nephrostomy (30%), shockwave lithotripsy (19%), or percutaneous nephrolithotripsy (17%). The risk of surgically treated kidney stones was no different between patients with cervical versus thoracolumbar SCI (3.4 vs 3.9 per 1000 person-years, HR 0.90, 95% CI 0.49-1.61). In their cohort, the 30-day mortality rate was low, and the 30-day admission rate to an intensive care unit was 12%. As might be expected, a history of surgically treated kidney stones prior to SCI (compared to no such history) was associated with a higher risk of kidney stones after SCI (27 vs 3 per 1000 person-years; adjusted HR 14.74, 95% CI 5.69-38.22).

In conclusion, Dr. Welk et al. demonstrated that during intermediate follow-up after SCI, surgically treated upper tract kidney stones occur in 1.3% of patients. Despite the expectation that PCNL would be the most commonly used treatment modality, based on the literature, ureteroscopy was seen as the most common treatment. A history of surgically managed kidney stones prior to SCI portends a higher risk of stones after SCI.

Presented by Blayne Welk, MD at the American Urological Association (AUA) Annual Meeting - May 4 - 8, 2013 - San Diego Convention Center - San Diego, California USA

Division of Urology, University of Western Ontario, Canada, at the 2013 AUA Meeting in San Diego, California, USA


Reported for by Michael Ordon, MD; UC Irvine Medical Center, Orange, CA USA

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