title: Calculus anuria in a spina bifida patient, who had solitary functioning kidney and recurrent renal calculi.
abstract: METHODS
  Clinical case report with comments by colleagues from Austria, Belgium, Germany, Japan, and Poland.
  
  
  OBJECTIVE
  To discuss challenges in the management of spinal bifida patients, who have marked kyphoscoliosis and no vascular access.
  
  
  METHODS
  Regional Spinal Injuries Centre, Southport, UK.
  
  
  METHODS
  A female patient, who was born with spina bifida, paraplegia and solitary right kidney, had undergone ileal loop urinary diversion. Renal calculi were noted in 1986. Percutaneous nephrostolithotomy was performed in 1989 and there was no residual stone fragment. However, she developed recurrence of calculi in the lower pole of the right kidney in 1991. Intravenous urography, performed in 1995, revealed right staghorn calculus and hydronephrosis. Chest X-ray showed markedly restricted lung volume due to severe kyphoscoliosis. In 2000, she was declared unsuitable for anaesthesia due to a lack of venous access and a high likelihood of difficulty in weaning off the ventilator in the postoperative period. In June 2002, she developed anuria (urine output=18 ml/24 h) due to ball-valve-type obstruction by a renal stone at the ureteropelvic junction. Urea: 14.4 mmol/l; creatinine: 236 microl/l. Ultrasound showed right hydronephrosis. Percutaneous nephrostomy was performed.
  
  
  RESULTS
  Following relief of urinary tract obstruction, there was postobstructive diuresis (3765 ml/24 h). However, the patient expired 19 days later due to progressive respiratory failure.
  
  
  CONCLUSIONS
  In this spina bifida patient, who had reached the age of 35 years, severe kyphoscoliosis and lack of vascular access presented insurmountable challenges to implement the desired surgical procedure for removal of stones from a solitary kidney.
authors.affiliation: Regional Spinal Injuries Centre, District General Hospital, Southport, UK.
authors.forename: S
authors.initials: S
authors.lastname: Vaidyanathan
authors.forename: B M
authors.initials: BM
authors.lastname: Soni
authors.forename: J-J
authors.initials: JJ
authors.lastname: Wyndaele
authors.forename: A Z
authors.initials: AZ
authors.lastname: Buczynski
authors.forename: E
authors.initials: E
authors.lastname: Iwatsubo
authors.forename: M
authors.initials: M
authors.lastname: Stoehrer
authors.forename: H
authors.initials: H
authors.lastname: Madersbacher
authors.forename: R
authors.initials: R
authors.lastname: Peschel
authors.forename: G
authors.initials: G
authors.lastname: Singh
authors.forename: J W H
authors.initials: JW
authors.lastname: Watt
authors.forename: P L
authors.initials: PL
authors.lastname: Hughes
authors.forename: P
authors.initials: P
authors.lastname: Sett
mesh_terms: D000328:Adult; D001002:Anuria / Q000150:complications / Q000000981:diagnostic imaging* / Q000601:surgery; D005260:Female; D006801:Humans; D007668:Kidney / Q000002:abnormalities / Q000473:pathology*; D007669:Kidney Calculi / Q000150:complications / Q000000981:diagnostic imaging* / Q000601:surgery; D011859:Radiography; D016135:Spinal Dysraphism / Q000150:complications / Q000000981:diagnostic imaging* / Q000601:surgery