title: The change in upper tract urolithiasis composition, surgical treatments and outcomes of para and quadriplegic patients over time.
abstract: Stone disease in patients with spinal cord injury is a source of morbidity and mortality. Previous studies have indicated a decrease in infection-based urolithiasis in recent decades. We aimed to identify changes in stone composition and surgical outcomes in patients with para and quadriplegia over time. A retrospective review of para and quadriplegic patients from 1986 to 2011 who underwent surgical intervention for urolithiasis was performed, identifying 95 patients. The Mantel-Haenszel Chi square test was used to compare change in stone composition over time. The mean patient age was 44.0 years (range 18-88) and treatment included percutaneous nephrolithotomy (PCNL) 40 (42.1 %), ureteroscopy 28 (29.5 %), shock wave lithotripsy (SWL) 26 (27.4 %), and nephrectomy 1 (1 %). Overall stone-free status was found in 47.4 % with 19.0 % requiring a repeat procedure. The median hospital stay for patients undergoing SWL was 2.5 days, ureteroscopy 5 days, and PCNL 6 days. Infection-based stone composition was identified in 23 patients (36.5 %). We evaluated the linear change in percent of each stone component over time and identified increasing components of calcium oxalate dihydrate (p = 0.002) and calcium carbonate (p = 0.009). However, over a period of 25 years, the incidence of infection-based stone did not change (p = 0.57). Para and quadriplegic patients with urolithiasis can be difficult to treat surgically with prolonged hospitalizations, low stone-free status, and often require additional procedures. Despite improvements in antibiotic agents and management of neurogenic bladders, infection-based calculi continue to be a significant source of morbidity to this patient population.
authors.affiliation: Department of Urology, Mayo Clinic, 200 First Street Southwest, Rochester, MN, 55905, USA.
authors.forename: Marisa M
authors.initials: MM
authors.lastname: Clifton
authors.forename: Matthew T
authors.initials: MT
authors.lastname: Gettman
authors.forename: David E
authors.initials: DE
authors.lastname: Patterson
authors.forename: Laureano
authors.initials: L
authors.lastname: Rangel
authors.forename: Amy E
authors.initials: AE
authors.lastname: Krambeck
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D007669:Kidney Calculi / Q000737:chemistry* / Q000209:etiology / Q000601:surgery*; D008297:Male; D010264:Paraplegia / Q000150:complications; D011782:Quadriplegia / Q000150:complications; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014514:Ureteral Calculi / Q000737:chemistry* / Q000209:etiology / Q000601:surgery*; D052878:Urolithiasis / Q000209:etiology / Q000601:surgery