Efficacy of percutaneous nephrolithotomy in patients with neurogenic bladder dysfunction/Norojen mesane disfonksiyonu olan hastalarda perkutan nefrolitotominin etkinligi

Aim: Patients with neurogenic bladder dysfunction (NBD) are at increased risk of urolithiasis. We review our experience with percutaneous nephrolithotomy (PCNL) on this group of patients with special attention paid to the risks of surgical complications. Methods: A total of 18 cases with NBD underwent PCNL at our institution. Neurogenous lesions included traumatic spinal cord injuries in 8 cases, sequel of cerebrovascular accident in 2, meningitis in 2, polio in 4 and kyphoscoliosis in 2. Percutaneous access was achieved under suoroscopic guidance with a patient in the prone position and tract was formed using balloon dilation system. Stone disintegration was accomplished with a pneumatic lithotripter. Results: There were 8 staghorn stones, 6 pelvi-calyceal stones, and 4 isolated renal pelvic stones. The mean operation time was 97.5[+ or -]18.7 (range: 80-120) minutes and the mean hospitalization time was 3 (range: 2-5) days. Stone-free status was achieved in 13 (72.2%) renal units. 4 (22%) patients with 2 staghorn stones and 2 pelvi-calyceal stones had clinically insignificant residual fragments (CIRF). Hydropneumothorax was encountered in 1 case with kyphoscoliosis, in whom an intercostal access was necessary. Conclusion: PCNL in patients with NBD is safe and effective, with outcomes comparable to that of patients without such a disorder. (The Medical Bulletin of Haseki 2010; 48: 76-9) Key Words: Neurogenic bladder dysfunction, urolithiasis, percutaneous nephrolithotomy Amac: Norojenik mesane disfonsiyonu (NMD) olan hastalar urolityazis acisindan yuksek risk tasirlar. Calismamizda cerrahi komplikasyonlar acisindan dikkat gosterilen bu hasta grubundaki perkutan nefrolitotomi (PCNL) tecrubelerimiz sunulmaktadir. Yontemler: Klinigimizde NMD ve bobrek tasi olan 18 hastaya PCNL uygulandi. Hastalarin 8'inde travmatik spinal kord yaralanmasi, 2'sinde serebrovaskuler atak sekeli, 2'sinde menenjit, 4'unde polio ve 2'sinde kifoskolyoza bagli norojenik hasar vardi. Ameliyathanede pron pozisyonda soroskopi altinda bobrege giris yapi ldiktan sonra balon dilatasyon ile giris yolu olusturuldu. Taslar pnomotik litotriptor ile parcalandi. Bulgular: Hastalarin 8'inde staghorn tas, 6'sinda pelvis ve kaliks tasi, 4'unde ise izole pelvis tasi vardi. Ortalama operasyon suresi 97.5[+ or -]18.7 (80-120) dakika, ortalama hastanede kalis suresi ise 3 (2-5) gun olarak saptandi. Hastalarin 13'unde (%72.2) tam tassizlik saglandi. Staghorn tasi olan 2 hastada ve pelvis ve kaliks tasi