title: Morbidity and efficacy of ureteroscopic stone treatment in patients with neurogenic bladder.
abstract: OBJECTIVE
  There is a lack of information on the safety and efficacy of ureteroscopy in the neurogenic bladder population. We hypothesized that ureteroscopy in patients with neurogenic bladder would be associated with an increased risk of complications and a lower stone clearance rate than in patients without neurological impairment.
  
  
  METHODS
  We reviewed a local registry of patients with ICD-9 codes for urolithiasis between 2004 and 2012. The study cohort was assembled from all eligible patients with neurogenic bladder and a randomly selected control group that had undergone ureteroscopy. Statistical analysis of demographic variables and surgical outcomes was performed. Complications were classified according to the Clavien system. Clearance was defined by computerized tomography, renal/bladder ultrasound or direct ureterorenoscopy.
  
  
  RESULTS
  Ureteroscopy was performed a total of 173 times in 127 controls and a total of 45 times in 20 patients with neurogenic bladder. There was no difference between presenting episodes by gender (p = 1.0), race (p = 0.654) or body mass index (p = 0.519). Bacteriuria was associated with the stone episode in 16.4% of controls and 67% of neurogenic bladder cases (p <0.001). Median operative time was significantly longer in those with neurogenic bladder (80.5 minutes, IQR 50-110.5 vs 52, IQR 33-78, p = 0.0003). The proportion of complications was significantly different (p = 0.013). Stones cleared in 86.6% of controls compared to 63% of neurogenic bladder cases (p = 0.004).
  
  
  CONCLUSIONS
  Patients with neurogenic bladder have increased morbidity after ureteroscopy for upper tract calculi compared to neurologically unaffected controls. Infection has a role in this morbidity. The clearance rate is lower but the stone burden is more significant in those with neurogenic bladder.
authors: Naval Medical Center San Diego, San Diego, California. Electronic address: matthew.christman@med.navy.mil.
authors: Matthew S
authors: MS
authors: Christman
authors: Angela
authors: A
authors: Kalmus
authors: Pasquale
authors: P
authors: Casale
mesh_terms: D000293:Adolescent; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007669:Kidney Calculi / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D009017:Morbidity / Q000639:trends; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D012307:Risk Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D018666:Ureteroscopy / Q000379:methods*; D001750:Urinary Bladder, Neurogenic / Q000150:complications*; D013520:Urologic Surgical Procedures / Q000379:methods*; D055815:Young Adult
keywords: NGB; PCNL; SWL; URS; bacteriuria; calculi; morbidity; neurogenic; neurogenic bladder; percutaneous nephrostolithotomy; shock wave lithotripsy; ureteroscopy; urinary bladder