Abstract
Urinary tract infection, disturbances in calcium metabolism, and vesico-renal reflux are the main causes of calculus formation in the efferent urinary ducts in paraplegics.
Intermittent catheterisation should be an important measure in the early treatment of patients with spinal cord injury. A large number of cases of urinary infection and the resulting fatalities can be avoided when such therapy is correctly and skilfully carried out. During the illness, isotope-nephrography can play an important role in the determination of renal function. In Germany, the care and treatment of paraplegics is not yet as well organised as in the Anglo-Saxon countries, where the frequency of stone formation (kidney and bladder stones) in this group is about two per cent; we observed staghorn calculi in approximately eight per cent of our paraplegic patients. Of the 29 patients (23 paraplegics and six tetraplegics), all but one had received previous treatment elsewhere before being seen by us. All patients referred to us arrived with a severe mixed infection of the urinary tract and B. proteus were isolated from all urine specimens.
We do not feel that the surgical removal of staghorn calculi in paraplegics should be a main goal. On the contrary a staghorn calculus which does not obstruct renal flow and which is accompanied by a ‘controllable’ infection should be operated upon only under the most favourable conditions.
Similar content being viewed by others
Log in or create a free account to read this content
Gain free access to this article, as well as selected content from this journal and more on nature.com
or
References
Aboulker, P & Bernard, E (1971). Phosphathaltige Nierenbeckenausgußsteine mit gramnegativer Begleitinfektion bei Traumen. Urologe, 10, 46.
Albrecht, K F (1971). Langfristige Ergebnisse in der Chirurgie korallenförmiger Steine. Urologe, 10, 46.
Arduino, M (1971). Spätergenisse in der Chirurgie der Korallensteine. Urologe, 10, 46.
Bors, E (1957). Neurogenic bladder. Urol. Survey, 7, 177–250.
Boshamer, K (1961). Morphologie und Genese der Harnsteine. In Alken/Dix/Weyrauch/ Wildbold: Handbuch d. Urol., Bd X. Springer-Verlag.
Britten, D & Ruedas, G (1970). Über den Einfluß von Blasendruckerhöhungen auf die Nierenfunktion. Urol int. 25, 76–80.
Büscher, H -K (1966). Probleme der Erstversorgung Querschnitts—gelähmter. Verhandlungsber. Dtsch. Ges. Urol., 21. Tg., Düsseldorf, 1965; Springer-Verlag.
BüScher, H -K (1961). Therapie der Nieren—und Harnleitersteine. In Alken/Dix/Weyrauch/Wildbold: Handbuch d. Urol. Band X. Springer-Verlag.
BüScher, H -K & Federschmidt, K (1963). Probleme der urologischen Versorgung der Querschnittsgelähmten. Urologe, 2, 384–391.
BüScher, H -K & Federschmidt, K (1966). Die Bedeutung des vesico-ureteralen Refluxes. Fortschr. Med. 84, 315–319.
Comarr, A -E (1961). Chronic infection of the urinary tract among patients with spinal cord injuries. J. Urol. 85, 983–987.
Comarr, A -E, Kawaichi, G K & Bors, E (1963). Renal calculosis of patients with traumatic cord lesion. J. Urol. 87, 647–656.
Dammanski, M (1963). Stone desease in paraplegia. Paraplegia, 1, 149–156.
Frankel, H (1969). Paraplegia, 7, 107.
Gibbon, N O V, Ross, J C & Silver, J R (1969). Changes in the upper urinary tract following various types of initial treatments. Paraplegia, 7, 63.
Guttmann, L (1966). Die Pathophysiologie und Behandlung der neurogenen Blase. Verhandlungsber. Dtsch. Ges. f. Urologie 21. Tg. Düsseldorf, 1965. Springer-Verlag.
Guttmann, L & Frankel, H (1966). The value of intermittent catheterisation in the early management of traumatic paraplegia and tetraplegia. Paraplegia, 4, 63–84.
Hasselbacher, K (1960). Nephrolithotomia transversa und partielle Nierenresektion. Z. Urol. 53, 656–662.
Hiensch, E & Schneider, H J (1966). Organ-saving surgical treatment of renal staghorn calculi. Urology and Nephrology, 1, 153–166.
Kaufmann, J & Götze, H (1968). Über die Bedeutung der Harnwegsinfektion für das Schicksal der Queschnittsgelähmten. Urologe, 7, 326–330.
Kollwitz, A -A (1963). Die Behandlung der querschnittsgelähmten Blase. Urologe, 2, 376–384.
Kracht, H, Kollwitz, A -A & Löhe, E (1970). Ergebnisse der Rezidivprophylaxe bei Phosphatsteinen mit Aluminiumgelen. Urologe, 9, 175–178.
Maddern, J P (1967). Surgery of the staghorn calculus. Brit. J. Urol. 39, 237–275.
Lutzeyer, W, Lymberopoulos, S & Terhorst, B (1970). Pyelolithotomia in situ. Urol. int. 25, 224.
Marchetti, L J & Ginick, P (1970). A comparison of renal function in spinal cord injury patients with and without reflux. J. Urol. 104, 365–367.
Marshall, V F, Lavengood, R W & Kelly, D (1965). Complete longitudinal nephrolithotomy and the Shorr regimen in the management of staghorn calculi. Ann. Surg. 162, 366–373.
Mauermeyer, W (1968). Möglichkeiten und Grenzen der organerhaltenden Steinchirurgie der Niere. Habilitationsschrift, TH München.
Paeslack, V, Roehl, F & zum Winkel, K (1964). Radio-isotope nephrographic studies in paraplegics. Paraplegia, 2, 246–252.
Palivoda, N I (1969). Vergleich der konservativen und operativen Therapie von Korallensteinen der Niere. Urologija i. nephrologija, 34, 3, 1969 ref. Z. Urol. 63, 516.
Sarre, H (1967). Nierenkrankheiten, G. Thieme-Verlag.
Schmitz, W (1967). Klinische Erfahrungen bei 70 Fällen von Nierenbeckenausgußsteinen. Urologe, 6, 239–243.
Sigel, A (1961). Die anatomische Grundlage der partiellen Nephrektomie. Urol. int. 11, 154–165.
Silver, J R (1963). The oxygen cost of breathing in tetraplegic patients. Paraplegia, 1. 204–214.
Smith, P H, Cook, J B & Robertson, W G (1969). Stone formation in paraplegia. Paraplegia, 7, 77–85.
Stöhr, Chr (1968). Verhütung von Steinbildungen in Harnsystem der Querschnittsgelähmten. Münch. med. Wschr. 170, 2308–2310.
Stoephasius, E (1970). Erste Ergebnisse nach l-jährigem Betrieb der neuen Station für Rückenmarksverletzte des Unfallkrhs. Murnau Med. Welt 21, 1900–1904.
Strohmenger, P (1968). Pyelotomie mit transrenaler Dauerspülung als organerhaltende Behandlung von Korallensteinen der Niere. Z. Urol. 57, 905–912.
Zielinski, J, Luciak, M, Czopik, J (1970). Plattenepithelkrebs des Nierenbeckens infolge von Ausgußsteinen. Z. Urol. 63, 883–886.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Kracht, H., Büscher, HK. Formation of staghorn calculi and their surgical implications in paraplegics and tetraplegics. Spinal Cord 12, 98–110 (1974). https://doi.org/10.1038/sc.1974.17
Issue date:
DOI: https://doi.org/10.1038/sc.1974.17
