title: Flexible ureteroscopic laser lithotripsy for upper urinary tract stone disease in patients with spinal cord injury.
abstract: The objective of this study is to present the outcomes of flexible ureteroscopic laser lithotripsy (URS) for upper urinary tract stone disease in spinal cord injury (SCI) patients performed by a single surgeon. A retrospective analysis was performed for SCI patients treated with flexible URS for proximal ureter and kidney stone disease by a single surgeon between 2003 and 2013. Patient characteristics, operative outcomes, metabolic evaluation, and stone analyses were assessed in detail. A total of 27 URS procedures were performed for urolithiasis in 21 renal units of 19 patients. The mean age was 52.1 ± 15.6 years (16-72) and mean BMI was 29.2 ± 7.3 kg/m(2) (20-45.7). Etiology of SCI was trauma (n: 10), multiple sclerosis (n: 6), cerebrovascular accident (n: 1), or undetermined (n: 2). The mean stone size was 15.9 ± 8.6 (6-40) mm. In the 27 URS procedures, stones were located in the ureter (n: 5), the kidney (n: 14), and both areas (n: 8). Mean hospitalization time was 2.0 ± 2.4 (0-10) days. Postoperative complications were observed in 6 cases (22.2%). Three major complications included urosepsis (n: 1) and respiratory failure (n: 2), that were observed postoperatively and required admission to the intensive care unit. The 2 minor complications were hypotension, fever and UTI, and required medical treatment. Fourteen (66.6%) of the 21 renal units were stone free. Calcium phosphate carbonate (n: 9) and struvite (n: 5) were the primary stone compositions detected. Hypocitraturia (n: 6), hypercalciuria (n: 5), hypernaturia (n: 5), hyperoxaluria (n: 4), and hyperuricosuria (n: 1) were common abnormalities in 24-h urine analysis. Ureteroscopic laser lithotripsy can be an effective treatment modality for SCI patients with upper urinary tract calculi.
authors.affiliation: Department of Urology, University of Wisconsin School of Medicine and Public Health, 1685 Highland Avenue, 3rd Floor, Madison, WI, 53705, USA. akadirtepeler@yahoo.com.
authors.forename: Abdulkadir
authors.initials: A
authors.lastname: Tepeler
authors.affiliation: Department of Urology, University of Wisconsin School of Medicine and Public Health, 1685 Highland Avenue, 3rd Floor, Madison, WI, 53705, USA.
authors.forename: Brian C
authors.initials: BC
authors.lastname: Sninsky
authors.affiliation: Department of Urology, University of Wisconsin School of Medicine and Public Health, 1685 Highland Avenue, 3rd Floor, Madison, WI, 53705, USA.
authors.forename: Stephen Y
authors.initials: SY
authors.lastname: Nakada
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D017602:Lithotripsy, Laser; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013119:Spinal Cord Injuries / Q000150:complications*; D018666:Ureteroscopy; D014545:Urinary Calculi / Q000209:etiology / Q000628:therapy*; D055815:Young Adult
keywords: Laser lithotripsy; Spinal cord injury; Ureteroscopy; Urolithiasis