Percutaneous Nephrolithotomy and Spina Bifida: Complex Major Stone Surgery?

Area of Science:

• Urology
• Nephrology
• Pediatric Surgery

Background:

• Spina bifida (SB) is associated with a substantially increased risk of kidney stone disease.
• This study uniquely compares percutaneous nephrolithotomy (PCNL) outcomes in SB patients versus a neurologically intact control group.

Purpose of the Study:

• To evaluate the outcomes of PCNL in patients with spina bifida (SB) compared to a control group.
• To identify specific risks and complications associated with PCNL in the SB population.

Main Methods:

• A retrospective analysis of 96 PCNL procedures in 13 SB patients and 50 non-SB patients.
• Data collected included comorbidities, preoperative renal function and ASA scores, intraoperative details (anesthesia time, tracks, stone-free rate), and postoperative outcomes (sepsis, ICU stay, transfusion, stone composition, nephrectomy).

Main Results:

• SB patients had higher ASA scores and operative times.
• Lower stone-free rates (46% vs 82%) were observed in the SB group.
• SB patients experienced significantly higher rates of sepsis (38% vs 1.6%), ICU/hospital stay, and transfusions, along with increased risk of repeat PCNL and nephrectomy.

Conclusions:

• PCNL in spina bifida patients is linked to increased peri-operative and postoperative morbidity.
• Patients with SB should be informed about elevated risks and higher stone recurrence rates.
• Separate outcome analysis for PCNL in SB patients may be warranted due to significant morbidity differences.