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Percutaneous Nephrolithotomy in Patients with Neurogenic Bladder Dysfunction
Matthew Mason, Sevann Helo, Noah Schenkman
University of Virginia, Charlottesville, VA

Introduction:
Patients with neurogenic bladder (NGB) dysfunction are at increased risk of urolithiasis, and frequently develop large renal stones requiring percutaneous nephrolithotomy (PNL). Patients with myelomeningocele (MMC) have NGB but typically have abnormal body habitus, making percutaneous access and surgical positioning more difficult. Recent literature suggests that the many patients with NGB possess metabolic rather than infectious stones.
Materials & Methods:
We reviewed the medical records of all patients who underwent PNL at our institution from 2001 to 2010. Patients with NGB were selected for this study. Comparison was made between patients with MMC versus other forms of neurologic disease.
Results:
A total of 26 patients with NGB underwent 39 PNL procedures between 2001 and 2010. The majority of patients had infectious stones. Major complications were sepsis or bleeding requiring transfusion. There was no significant difference in stone size, peri-operative complications, stone composition, stone-free rate, or radiation exposure between patients with or without MMC.

Results
MMCNon-MMCAll NGB patientsp-value
Patients (#)111526
Stone procedure episodes (#)182139
Avg peri-op decrease in Hct (%)5.34.14.60.53
Avg peri-op change in GFR (mL/min)-6-15-110.17
Major peri-op complications11%5%8%0.46
Avg initial stone area (mm2)4235805130.31
Patients with infectious stones80%88%84%0.57
Stone free at 3 months64%56%59%0.62
Avg fluoro dose (mGy)10319019590.71

Conclusions:

Our experience failed to confirm recent reports suggesting a high number of metabolic stones, and supports previous findings that this population has a high percentage of infection stones. Despite the abnormal body habitus of most patients with myelomeningocele, PNL remains equally effective and safe when compared to other patients with NGB and normal body habitus.


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