Presentation Authors: Ismaël Chelghaf*, Pascal Glemain, François-Xavier Madec, Loïc Le Normand, Jerome Rigaud, Julien Branchereau, Marie-Aimee Perrouin-Verbe, Nantes, France
Introduction: Percutaneous nephrolithotomy (PCNL) can be challenging in patients with neurological disease, in particular due to their body habitus and/or spinal abnormalities.The aim of the study was to report the safety and efficacy of PCNL for renal stones in patients with neurogenic bladder.
Methods: Between 2005 and 2017, all patients with neurogenic bladder who underwent PCNL for renal stones were retrospectively enrolled in the study.Succes was defined as stone-free status, and was assessed per operatively (visual completion) or at 6 months by follow-up imaging (CT-scan or ultrasonography).Early post-operative complications were reported according to Clavien-Dindo classification.
Results: Over the study period, 76 procedures were performed on 54 patients to treat 68 kidneys. The success rate was 60,5%. For 15,8% of procedures, this goal was achieved in 2 times, and for 31,6%, a new procedure was required within 3 years. The sex (male), staghorn renal stone, and a high stone burden were associated with a higher risk of failure (p < 0.04; < 0.02 and < 0.005 respectively)(figure).Twenty-six minor complications occurred (34,2%). Eight (10,5%) severe complications (Clavien Dindo>2) were observed, including 3 pseudoaneurysms, 1 nephrectomy, and 3 death related to sepsis (3,9%). The main complication was urosepsis occurring in 25% of cases. Among 62,5% of them, there was a mismatch concerning the bacteria isolated on pre and post-operative urine cultures. Blood transfusions were needed for 18,4% of cases.
Conclusions: PCNL is a challenging procedure in patients with neurological disease sometimes due to modified anatomy and installation constraints. However, this procedure seems to be the best to obtain a high stone free rate for large renal stones (> 20mm) in this specific population, which is the main goal. Low grade complication is frequent, and the success rate is lower than the overall population. Urosepsis was the most frequent and severe complication. To decrease operating time and to obtain preoperative adequate urine culture (renal sample) may improve this morbidity.