Percutaneous nephrolithotomy in patients with spinal cord injury: should all these patients be automatically assigned a
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ORIGINAL ARTICLE
Percutaneous nephrolithotomy in patients with spinal cord injury: should all these patients be automatically assigned a Guy’s stone score of 4? Fabio C. M. Torricelli1 · Fabio C. Vicentini1,3 · Lucas Zanetti2 · Rodrigo Perrella3 · Giovanni S. Marchini1 · Alexandre Danilovic1 · Carlos A. Batagello1 · Claudio B. Murta3 · Joaquim F. A. Claro3 · Miguel Srougi1 · William C. Nahas1 · Eduardo Mazzucchi1 Received: 12 June 2020 / Accepted: 5 September 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose To assess the complication and stone-free rates of PCNL in patients with spinal cord injury (SCI) and to evaluate whether this population should be assigned a Guy’s stone score (GSS) of 4. Methods A case–control study was conducted, and electronic charts were reviewed to search for patients with SCI, bladder dysfunction, and kidney stones who had undergone PCNL. Control cases were randomly selected from among patients with complete staghorn calculus (GSS = 4). Results One hundred and seventeen patients were included. Patients with SCI had a significant shorter operative time (119 vs. 141 min; p = 0.018). There were no significant differences between the groups in terms of the patients’ position, number of renal tracts, bleeding or transfusion rate; however, there was a significantly higher complication rate (23.1% vs. 7.8%; p = 0.009) and a longer hospital stay (5.8 vs. 3.1 days; p = 0.002) among patients with SCI. With regards to the stone-free rate in patients with different grades of GSS patients with SCI who had a GSS of 1 had a stone-free rate of 85.7%, while those with a GSS of 2, 3, or 4 had 50%, 50%, and 31.5%, respectively (p = 0.024). Only patients with a GSS of 4 in the SCI group had outcomes that were similar to those of control patients (31.5% vs. 31.6%). Conclusion Patients with SCI should not be automatically assigned GSS 4. Stone-free rate is related to stone burden in these patients, although they do show a higher complication rate and a longer hospital stay than non-neurological patients. Keywords Complications · Kidney · Lithotripsy · Urinary calculi
Introduction Fabio C. M. Torricelli and Fabio C. Vicentini contributed equally to this manuscript. Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00345-020-03443-1) contains supplementary material, which is available to authorized users. * Fabio C. M. Torricelli [email protected] 1
Division of Urology, University of Sao Paulo Medical School, Av. Vereador Jose Diniz, 3300, conj. 208, Sao Paulo, SP 04604‑006, Brazil
2
Faculdade das Américas School of Medicine, Sao Paulo, SP, Brazil
3
Division of Urology, Hospital Brigadeiro, Sao Paulo, SP, Brazil
The prevalence of urolithiasis in the upper urinary tract is increasing [1, 2]. In patients with spinal cord injuries who have bladder dysfunction, this condition is especially complex, since factors such as urinary stasis and bacteriuria increase the risk for kidney stone formation, with c
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