Formation of staghorn calculi and their surgical implications in paraplegics and tetraplegics.

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.