struvite and Spinal-Cord-Injuries

To evaluate the association of clinical factors on outcomes in patients with spinal cord injury (SCI) undergoing ureteroscopy. Immobility, recurrent urinary tract infection, and lower urinary tract dysfunction contribute to renal stone formation in patients with SCI. Ureteroscopy is a commonly utilized treatment modality; however, surgical complication rates and outcomes have been poorly defined. Evidence guiding safe and effective treatment of stones in this cohort remains scarce.. Records were retrospectively reviewed for patients with SCI who underwent ureteroscopy for kidney stones from 1996 to 2014 at a single institution. Multivariate relationships were evaluated using a general estimating equation model.. Forty-six patients with SCI underwent a total of 95 ureteroscopic procedures. After treatment, stone-free rate was 17% and 20% with <2-mm fragments. The complication rate was 21%. On multivariate analysis, SCI in cervical (C) levels was associated with higher risk of complications (C3: odds ratio [OR] 3.83, 95% confidence interval [CI] 2.17-6.98; C6: OR 3.83, 95% CI 1.08-13.53). American Spinal Injury Association Scale A classification was associated with a lower probability of stone-free status (OR 0.16, 95% CI 0.03-0.82). Patients averaged 2.2 procedures yet more procedures were associated with lower stone-free status (OR 0.83, 95% CI 0.03-0.32). Chronic obstructive pulmonary disease and bladder management modality were not associated with stone-free status or complications.. In patients with SCI, higher injury level and complete SCI were associated with worse stone clearance and more complications. Stone-free rate was 17%. Overall, flexible ureteroscopy is a relatively safe procedure in this population. Alternative strategies should be considered after failed ureteroscopy.

Topics: Adult; Aged; Apatites; Cardiovascular Diseases; Comorbidity; Diabetes Mellitus; Female; Humans; Kidney Calculi; Lithotripsy, Laser; Male; Middle Aged; Multivariate Analysis; Operative Time; Postoperative Complications; Renal Insufficiency, Chronic; Respiratory Tract Diseases; Spinal Cord Injuries; Struvite; Treatment Outcome; Ureteroscopy; Urinary Bladder, Neurogenic; Urinary Tract Infections

Bladder calculi are a common problem in those with spinal cord injury (SCI). Detection is important to prevent complications.. To determine the accuracy of bladder stone detection by abdominal x-rays.. X-ray reports from individuals with SCI with known bladder stones detected by cystoscopy were reviewed.. X-ray reports noted the presence or absence of bladder stones. The stone variables evaluated were stone composition (crystallographic analysis), widest dimension of the largest stone (during cystoscopy), and the total volume (cm3) of the stone mass removed.. Sixty-two consecutive x-ray reports from individuals with bladder stones were reviewed. The majority of stones were calcium phosphate (46.8%) or struvite (26.7%). Regarding stone composition, the detection by x-ray was 28.6% for struvite stones and 41.9% for calcium phosphate stones. Regarding diameter of largest stone, the detection by x-ray was 14% for stones < 0.5 cm, 0% for stones 0.5 cm to 0.9 cm, 33% for stones 1.0 cm to 1.49 cm, 33% for stones 1.5 cm to 1.9 cm, and 54% for stones > or = 2.0 cm. Regarding total volume of stones, the detection by x-ray was 0% for volumes < 0.2 cm3, 33% for volumes 0.2 cm3 to 0.39 cm3, 60% for volumes 0.40 cm3 to 0.59 cm3, 40% for volumes of 0.60 cm3 to 0.79 cm3, 0% for stones from 0.8 cm3 to 0.99 cm3, and 57% for volumes > or = 1.0 cm3. Overall, 13/62 (20.97%) of stones found during cystoscopy were detected by the x-ray.. Abdominal x-ray is not a reliable method to detect bladder stones in individuals with SCI.

Topics: Adult; Calcium Oxalate; Calcium Phosphates; Cystoscopy; Female; Humans; Magnesium Compounds; Male; Phosphates; Radiography; Sensitivity and Specificity; Spinal Cord Injuries; Struvite; Uric Acid; Urinary Bladder Calculi; Urinary Bladder, Neurogenic

An aggregometer technique was used to study urease-induced crystallizations in synthetic urine and human urine from healthy subjects and patients with chronic spinal cord injuries. The two different phases of crystallization, calcium phosphate and magnesium ammonium phosphate, were easily evaluated with a single assay using this technique. The crystallization of calcium phosphate and magnesium ammonium phosphate varied markedly among the different urine specimens after incubation with urease. The turbidity curves from human urine were divided into four patterns. We assumed that the variations in the patterns of the turbidity curves appeared to be mainly due to differences in the composition of the urine and in the original pH, and that the calcium and magnesium concentrations were very important in the urinary constituents.

Topics: Calcium Phosphates; Crystallization; Female; Humans; Hydrogen-Ion Concentration; Magnesium Compounds; Male; Phosphates; Spinal Cord Injuries; Struvite; Urease

The composition of the stone was determined in 24 paraplegic patients from whom 26 stones were surgically removed. Twenty-five of the 26 stones consisted of 90 per cent magnesium ammonium phosphate and 10 per cent carbonate apatite. The remaining single stone was composed of 90 per cent calcium oxalate and 10 per cent magnesium ammonium phosphate. Renal function improved significantly with the removal of the stones.

Topics: Adult; Aged; Humans; Magnesium; Magnesium Compounds; Male; Middle Aged; Paraplegia; Phosphates; Spinal Cord Injuries; Struvite; Urinary Calculi; Urinary Tract Infections