title: The surgical management of upper tract stone disease among spinal cord-injured patients.
abstract: METHODS
  Retrospective cohort study, using linked, population-based health-care data.
  
  
  OBJECTIVE
  To describe the incidence, management and outcomes of surgically treated kidney stones after spinal cord injury (SCI). To evaluate the impact of a past history of kidney stones on the occurrence of kidney stones.
  
  
  METHODS
  Ontario, Canada.
  
  
  METHODS
  A total of 5121 patients were followed a median of 4 years after an incident SCI (occurring between 2002 and 2011). The primary outcome was surgical intervention for upper tract kidney stones.
  
  
  RESULTS
  In follow-up, 66 patients (1.3%) had 89 episodes of surgically treated kidney stones. Treatments included: ureteroscopic lithotripsy (34%), ureteral stent/percutaneous nephrostomy (30%), shockwave lithotripsy (19%) or percutaneous nephrolithotripsy (17%). Following stone treatment, the 30-day mortality rate was low, and the 30-day admission rate to an intensive care unit was 12%. A history of surgically treated kidney stones before SCI (compared with no such history) was associated with a higher risk of kidney stones after SCI (27 vs 3 per 1000 person-years; adjusted hazard ratio 14.74, 95% confidence interval 5.69-38.22).
  
  
  CONCLUSIONS
  During intermediate follow-up after SCI, surgically treated upper tract kidney stones occur in 1.3% of patients. Ureteroscopy with lithotripsy is the most common treatment. A history of surgically managed kidney stones before SCI portends a higher risk of stones after SCI.
authors.affiliation: Division of Urology, Department of Surgery, Western University, London, Ontario, Canada. Blayne.welk@sjhc.london.on.ca
authors.forename: B
authors.initials: B
authors.lastname: Welk
authors.forename: S
authors.initials: S
authors.lastname: Shariff
authors.forename: M
authors.initials: M
authors.lastname: Ordon
authors.forename: B
authors.initials: B
authors.lastname: Catharine Craven
authors.forename: S
authors.initials: S
authors.lastname: Herschorn
authors.forename: A X
authors.initials: AX
authors.lastname: Garg
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D005260:Female; D006801:Humans; D015994:Incidence; D007669:Kidney Calculi / Q000150:complications* / Q000453:epidemiology / Q000601:surgery*; D008096:Lithotripsy / Q000379:methods; D008297:Male; D008875:Middle Aged; D009403:Nephrostomy, Percutaneous; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D013119:Spinal Cord Injuries / Q000150:complications*; D014514:Ureteral Calculi / Q000150:complications* / Q000453:epidemiology / Q000601:surgery*; D018666:Ureteroscopy