Outcomes and challenges in percutaneous nephrolithotomy for neurogenic bladder patients.

Abstract

Introduction: Neurogenic bladder secondary to conditions such as multiple sclerosis (MS) disease. However, the anatomy or physiology in neurogenic bladder patients can increase the complexity of PCNL. This study aims to assess the stone-free rate and complications associated with PCNL in neurogenic bladder patients from a single institution. Method(s): A retrospective analysis was conducted of all neurogenic bladder patients who underwent PCNL at our institution from 2020-2023. Patient demographics, operative details, stone sizes, and complications were extracted from electronic medical records. Complications were graded using the Clavien-Dindo classification system. Result(s): A total of 16 patients were included in the analysis (9 females, 7 males; mean age 52 years). SB, CP, MS and SCI accounted for 6, 6, 2, and 2 cases respectively. The mean preoperative stone size was 17mm. The overall stone free rate was 50%, with a mean residual stone size of 13mm. During the median 10-month follow-up, 50% of patients required a further procedure under general anesthesia. Complications occurred in 25% of cases, including two Grade 2 complications necessitating intravenous antibiotics, and two Grade 4 complications, involving symptomatic blood loss and intra-operative bowel injury. Conclusion(s): Our study highlights the ongoing management challenges for neurogenic bladder patients in achieving stonefree disease. The complications highlight the importance of post-operative care in mitigating adverse events. Continued efforts to optimize surgical strategies are essential to improving outcomes in this patient population.