Efficacy of Percutaneous Nephrolithotomy in Patients with Neurogenic Bladder Dysfunction

Abstract

Aim: Patients with neurogenic bladder dysfunction (NBD) are at increased risk of urolithiasis. We review our experience with percutaneous nephrolithotomy (PCNL) on this group of patients with special attention paid to the risks of surgical complications. Methods: A total of 18 cases with NBD underwent PCNL at our institution. Neurogenous lesions included traumatic spinal cord injuries in 8 cases, sequel of cerebrovascular accident in 2, meningitis in 2, polio in 4 and kyphoscoliosis in 2. Percutaneous access was achieved under fluoroscopic guidance with a patient in the prone position and tract was formed using balloon dilation system. Stone disintegration was accomplished with a pneumatic lithotripter. Results: There were 8 staghorn stones, 6 pelvi-calyceal stones, and 4 isolated renal pelvic stones. The mean operation time was 97.5±18.7 (range: 80-120) minutes and the mean hospitalization time was 3 (range: 2-5) days. Stone-free status was achieved in 13 (72.2%) renal units. 4 (22%) patients with 2 staghorn stones and 2 pelvi-calyceal stones had clinically insignificant residual fragments (CIRF). Hydropneumothorax was encountered in 1 case with kyphoscoliosis, in whom an intercostal access was necessary. Conclusion: PCNL in patients with NBD is safe and effective, with outcomes comparable to that of patients without such a disorder. (The Medical Bulletin of Haseki 2010; 48: 76-9)

Keywords

• Neurogenic bladder dysfunction
• urolithiasis
• percutaneous nephrolithotomy