title: Percutaneous nephrolithotomy in adult patients with spina bifida, severe spinal deformity and large renal stones.
abstract: OBJECTIVE
  To present our experience in patients with spina bifida with severe spinal abnormality undergoing percutaneous nephrolithotomy (PCNL) for large stone burden.
  
  
  METHODS
  A retrospective review identified five spina bifida patients with abnormal spinal curvature who had a PCNL for large kidney stones. The mean age was 28 years. In two patients, stones were on the concave side of the scoliotic spine further limiting percutaneous access. Mean stone burden was 940 mm2. All patients were paraplegic, three patients had symptomatic stone disease. We performed initial percutaneous renal access in radiology department and staged nephrolithotomy in operating room. Tract dilatation was accomplished using Amplatz dilators and a 24 Ch or 26 Ch nephroscope was used. Fragmentation and stone removal were accomplished in all patients using pneumatic and or ultrasound lithotripter and a retrieval grasper.
  
  
  RESULTS
  No anaesthetic complications were recorded. One patient required multiple percutaneous tracts, four had single tract to access stones. Three patients were stone free after PCNL. One required second PCNL through the same tract and another patient had multiple adjunctive ESWL. All five patients were stone clear after the final procedure. Two patients required blood transfusion. No patient had major complication or admission to intensive care unit.
  
  
  CONCLUSIONS
  Percutaneous nephrolithotomy in patients with spina bifida is challenging but safe. Detailed pre-operative anaesthetic assessment and precise uroradiological evaluation of renal anatomy is essential. Second-look PCNL and additional ESWL/URS treatment may be required to completely clear stones.
authors.affiliation: Department of Urology, The Adelaide and Meath Hospital Dublin, Incorporating The National Children's Hospital, Tallaght, Dublin 24, Ireland. alsinnawi@hotmail.com
authors.forename: M
authors.initials: M
authors.lastname: Alsinnawi
authors.forename: W C
authors.initials: WC
authors.lastname: Torreggiani
authors.forename: R
authors.initials: R
authors.lastname: Flynn
authors.forename: T E D
authors.initials: TE
authors.lastname: McDermott
authors.forename: R
authors.initials: R
authors.lastname: Grainger
authors.forename: J A
authors.initials: JA
authors.lastname: Thornhill
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D007668:Kidney / Q000601:surgery; D007669:Kidney Calculi / Q000150:complications* / Q000601:surgery*; D008297:Male; D009403:Nephrostomy, Percutaneous / Q000379:methods*; D012189:Retrospective Studies; D016135:Spinal Dysraphism / Q000150:complications*; D055815:Young Adult