Many individuals who sustain a spinal cord injury (SCI) experience weakness or paralysis below the waist, which typically impairs urinary function. As a result, people with SCI are at a significantly higher risk of developing kidney stones, an extremely painful condition that occurs when mineral deposits form in the kidneys.
Clinicians successfully manage kidney stones in the general population using a technique called ureteroscopy. During this procedure, clinicians use a small camera to examine the upper urinary tract to diagnose the cause of kidney stones and to break these deposits into smaller pieces. Although ureteroscopy is known to reduce or end the development of kidney stones by 77 to 93 percent among non-injured patients, clinicians are unsure if ureteroscopy is a viable method for managing this painful, debilitating condition among people with SCI.
A recent study in the United Kingdom studied ureteroscopy in 21 patients with SCI. They found that 42 percent of these patients suffered from kidney stones, a significantly higher proportion than the general population. The researchers determined that the average size of the stones was 27 mm. In most cases, any kidney stones larger than 20 mm are treated using percutaneous nephrolithotomy (PCNL), an invasive procedure that may be incompatible with the anatomy of SCI patients. Rather than use PCNL for patients with large stones, the research team performed ureteroscopy on the patients. They found that 47 percent of them remained stone-free, indicating that a large stone burden can be successfully managed using ureteroscopy alone.
Urinary dysfunction can be painful, debilitating, and dangerous for people with SCI. Fortunately, procedures like ureteroscopy are a promising option for reducing the occurrence of kidney stones in these patients. Given the high prevalence of kidney stones after SCI, clinicians are advised to increase screening efforts among all SCI patients to ensure that kidney stones are identified and removed before further complications can occur.
Prattley S, Oliver R, New F, et al. Ureteroscopy in patients with spinal cord injury: Outcomes from a spinal injury unit and a review of literature. Translational Andrology and Urology. (September 2019).