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Higher Frequency of Stone-Related Procedures in Patients with Neurogenic Bladder: A National Review Using a Live Claims Database
Jacob Bleau, B.S.1, Benjamin Rubin, B.S.
1, Angelina Kuzina, B.S.
1, Sarah Kohl, B.S.
1, Nicholas Khoo, B.S.
1, Mohammad Mohaghegh, M.D, FRCSC
2, Richard Grunert, M.D.
2, Brian Irwin, M.D.
2.
1The Robert Larner, M.D. College of Medicine at the University of Vermont, Burlington, VT, USA,
2The University of Vermont Medical Center, Burlington, VT, USA.
BACKGROUND: Patients with neurogenic bladder (NB) are at increased risk for urinary complications. Impaired bladder emptying, recurrent infections, and metabolic abnormalities contribute to stone formation, leading to higher morbidity and a greater need for surgical intervention. This study examines the relationship between NB and urinary tract stone disease, analyzing incidence, procedural intervention rates, and treatment patterns from 2005 to the present.
METHODS: We conducted a retrospective cohort analysis using the TriNetX database. Patients with NB were identified using ICD-10 codes. Incidence and prevalence of urinary tract stones were assessed, and procedural intervention rates were compared with a propensity score-matched control group of non-NB patients with stones. CPT codes were used to identify ureteroscopy, percutaneous nephrolithotomy (PCNL), and extracorporeal shockwave lithotripsy (ESWL). Statistical significance was assessed using odds ratios and p-values (p<0.05).
RESULTS: The prevalence of urinary tract stones in the NB cohort was 12.26% (p<0.0001), with an incidence of 8.53% (p<0.0001).
Stone-related procedures were more frequent in NB patients (10.32%) than in controls (7.7%) (p<0.0001), with an odds ratio of 1.38 (95% CI: 1.32-1.44). Ureteroscopy was performed in 0.387% of NB patients who had urinary tract stones versus 0.248% of controls (p=0.0002). PCNL rates were significantly higher in the NB cohort (2.891% vs. 1.326%, p<0.0001), while ESWL was performed less frequently (1.592% vs. 2.348%, p<0.0001).
CONCLUSIONS: Patients with NB were found to have rates of urinary tract stone disease that are consistent with current literature, and they were at a significantly higher risk of undergoing procedures for urinary tract stones. These findings highlight the need for tailored management strategies and surveillance protocols to optimize care in this high-risk population.
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