Extracorporeal shock wave lithotripsy, ureterolithotripsy, and percutaneous nephrolithotripsy challenges in managing spinal cord neuropathy patients. Lessons learned from a scoping review.

IF 1.4 Q3 UROLOGY & NEPHROLOGY Central European Journal of Urology Pub Date : 2024-01-01 Epub Date: 2024-01-11 DOI:10.5173/ceju.2023.123
Daniele Castellani, Carlo Brocca, Demetra Fuligni, Carlo Giulioni, Angelo Antezza, Angelo Cormio, Arianna Rubino, Lucia Pitoni, Virgilio De Stefano, Giulio Milanese, Luigi Cormio, Bhaskar Kumar Somani, Vineet Gauhar, Andrea Benedetto Galosi
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Abstract

Introduction: We aim to review the outcomes of shock wave lithotripsy (SWL), ureteroscopy, and percutaneous nephrolithotripsy (PCNL) for renal and ureteral stones in spinal cord neuropathy patients (SNP).

Material and methods: A literature search was performed on 8th March 2023 using PubMed, EMBASE, and Google Scholar with no date limit. Preclinical/animal studies, reviews, letters to the editor, case reports, and meeting abstracts were excluded. Only English papers were accepted.

Results: Thirty-five articles were accepted. Five studies focused on SWL, 17 on PCNL, and 6 on ureteroscopy. The remaining articles employed more than one procedure. Stone composition has shifted from struvite to the more common calcium phosphate. SWL showed a very poor stone-free rate (SFR) likely due to challenges in patient positioning, stone visualization, localization, and inability to pass fragments spontaneously. Flexible ureteroscopy and PCNL were associated with a high incidence of infectious complications, long hospital stays, high blood transfusion rate, and intensive care admissions. There were also cases of death. Both procedures were challenging due to genitourinary reconstruction, scoliosis and kyphosis, rib-cage deformity, lower limb contractures, and severe comorbidity which also affected anesthesia. SFR was lower than in non-neurological patients.

Conclusions: SWL, ureterolithotripsy, and PCNL should be considered challenging procedures in SNP due to positioning issues, an increased risk of intra and peri-operative morbidity, and even mortality. Computed tomography should be recommended to assess residual fragments as it becomes imperative to minimize a re-intervention in SNP who should be preferably treated in referral centers.

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体外冲击波碎石术、输尿管碎石术和经皮肾镜碎石术在治疗脊髓神经病患者方面面临的挑战。从范围审查中汲取的经验教训。
简介:我们旨在回顾冲击波碎石术(SWL)、输尿管镜检查和经皮肾镜碎石术(PCNL)治疗脊髓神经病患者(SNP)肾结石和输尿管结石的效果:于 2023 年 3 月 8 日使用 PubMed、EMBASE 和 Google Scholar 进行文献检索,无日期限制。不包括临床前/动物研究、综述、致编辑的信、病例报告和会议摘要。只接受英文论文:结果:35 篇文章被接受。其中 5 篇侧重于 SWL,17 篇侧重于 PCNL,6 篇侧重于输尿管镜检查。其余文章采用了一种以上的手术方法。结石成分已从硬石转变为更常见的磷酸钙。SWL显示的无结石率(SFR)非常低,这可能是由于患者体位、结石可视化、定位以及无法自发排出碎片等方面的挑战。柔性输尿管镜检查和 PCNL 的感染性并发症发生率高、住院时间长、输血率高、需要重症监护。也有死亡病例。由于生殖泌尿系统重建、脊柱侧弯和脊柱后凸、肋骨-胸廓畸形、下肢挛缩以及严重的合并症,这两种手术都具有挑战性,也影响了麻醉效果。SFR低于非神经科患者:由于定位问题、术中和围手术期发病风险增加,甚至死亡率增加,SWL、输尿管碎石术和 PCNL 应被视为对 SNP 患者具有挑战性的手术。应建议使用计算机断层扫描评估残余碎片,因为必须尽量减少SNP患者的再次介入,这些患者最好在转诊中心接受治疗。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Central European Journal of Urology
Central European Journal of Urology UROLOGY & NEPHROLOGY-
CiteScore
2.30
自引率
8.30%
发文量
48
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