title: Ureteroscopy with laser lithotripsy for urolithiasis in the spinal cord injury population.
abstract: METHODS
  Retrospective study.
  
  
  OBJECTIVE
  The purpose of this investigation was to review the outcomes and safety of retrograde ureteroscopic laser lithotripsy (URS) for the treatment of urolithiasis in the spinal cord injury (SCI) population.
  
  
  METHODS
  Virginia, USA.
  
  
  METHODS
  All patients with SCI who underwent URS with holmium:YAG laser lithotripsy for urolithiasis over a 15-year period were identified. Stone size, location and number at presentation were recorded. Information regarding patient characteristics, intra-operative complications, surgical efficacy, stone clearance, peri-operative complications, and follow-up stone events was collected and analyzed.
  
  
  RESULTS
  A total of 67 URS procedures were performed on 29 SCI patients during the study period with an average follow-up of 3.4 years. Patients had an average of 2.3 ipsilateral ureteroscopies. The majority (85.1%) used indwelling catheters for long-term bladder management, and complete stone clearance after the first procedure was 34.3%. Of the 44 cases with residual stones >4 mm, 20 (45.5%) were secondary to technical or procedural limitations. The intra-operative complication rate was comparable to non-SCI studies at 1.5%, but peri-operative complications were significantly higher at 29.9% with the majority due to urosepsis. Factors associated with peri-operative complications include chronic obstructive pulmonary disease, motor incomplete injuries and lack of a pre-operative ureteral stent.
  
  
  CONCLUSIONS
  URS in the SCI population is an effective treatment for ureteral or renal stones but may be associated with greater risks and reduced efficacy.
authors: Department of Spinal Cord Injury and Disorders, Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond, VA, USA.
authors: T
authors: T
authors: Wolfe
authors: A P
authors: AP
authors: Klausner
authors: L L
authors: LL
authors: Goetz
authors: A B
authors: AB
authors: King
authors: T
authors: T
authors: Hudson
authors: D R
authors: DR
authors: Gater
mesh_terms: D000328:Adult; D006801:Humans; D053844:Lasers, Solid-State; D017602:Lithotripsy, Laser / Q000009:adverse effects / Q000379:methods; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013119:Spinal Cord Injuries / Q000150:complications*; D016896:Treatment Outcome; D018666:Ureteroscopy / Q000009:adverse effects / Q000379:methods; D052878:Urolithiasis / Q000150:complications* / Q000628:therapy*