PCNL in neurogenic bladder: A challenging population for both clinical management and analysis

BJUI Compass, 2023 · DOI: 10.1002/bco2.268 · Published: January 1, 2023

Simple Explanation

Patients with neurogenic bladder, often due to spinal cord injury (SCI), face a higher risk of developing kidney stones. This study reviews the outcomes of percutaneous nephrolithotomy (PCNL), a surgical procedure to remove kidney stones, in these patients. PCNL is a well-established method for treating kidney stones, but patients with neurogenic bladder can present unique challenges due to anatomical or physiological abnormalities. These challenges can affect patient positioning, access to the kidney, and increase the risk of complications. This study aims to evaluate the safety and effectiveness of PCNL in patients with neurogenic bladder, specifically focusing on peri-operative morbidity (complications during and after surgery) at a single institution.

Study Duration

11 Years

Participants

52 patients with neurogenic bladder or urinary diversion

Evidence Level

Retrospective review

Key Findings

1
PCNL remains an acceptably safe and efficacious treatment option for patients with neurogenic bladders who have upper tract stone disease, especially when alternative approaches like ureteroscopy are not feasible.
2
A significant proportion of patients required PCNL because alternative treatments like ureteroscopy were not possible due to conditions like limb contractures resulting from SCI.
3
The study observed a moderate overall complication rate, with low rates of ICU admission and major complications, suggesting that with careful patient selection and management, PCNL can be performed safely in this challenging population.

Research Summary

This retrospective study reviewed the management of patients with neurogenic bladder undergoing PCNL over a decade, finding that PCNL remains a valuable option when ureteroscopy is not feasible. The study highlights the challenges in managing this population due to anatomical and physiological abnormalities, which can increase the risk of complications and affect treatment outcomes. Despite the challenges, the study concludes that PCNL can be performed safely with acceptable complication rates if an individualized approach is taken, and the potential risks are carefully considered.

Practical Implications

Individualized Treatment Planning

Treatment plans should be customized based on the patient's anatomy, stone characteristics, and individual risk factors, with thorough preoperative imaging and consideration of alternative access strategies.

Proactive Infection Management

Aggressive preoperative management of UTIs with appropriate antibiotics is critical to minimize postoperative infectious complications.

Increased Postoperative Monitoring

Patients with neurogenic bladder undergoing PCNL should be considered at higher risk for complications and may benefit from closer postoperative monitoring in the ICU or HDU.

Study Limitations

1
Small sample size, limiting statistical power for subgroup comparisons.
2
Retrospective design, which is subject to biases and missing data.
3
Lack of a control group of neurogenic bladder patients managed non-operatively.

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