MP95-12 CHANGING LITHOGENIC TRENDS IN PATIENTS WITH NEUROLOGICALLY DERIVED MUSCULOSKELETAL DEFICIENCIES (NDMD)

Abstract

You have accessJournal of UrologyStone Disease: Epidemiology & Evaluation II1 Apr 2017MP95-12 CHANGING LITHOGENIC TRENDS IN PATIENTS WITH NEUROLOGICALLY DERIVED MUSCULOSKELETAL DEFICIENCIES (NDMD) Lee Hugar, Ilan Kafka, Sara Sprauer, Michelle Yu, Thomas Fuller, Hassan Taan, Timothy Averch, and Michelle Semins Lee HugarLee Hugar More articles by this author , Ilan KafkaIlan Kafka More articles by this author , Sara SprauerSara Sprauer More articles by this author , Michelle YuMichelle Yu More articles by this author , Thomas FullerThomas Fuller More articles by this author , Hassan TaanHassan Taan More articles by this author , Timothy AverchTimothy Averch More articles by this author , and Michelle SeminsMichelle Semins More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.3014AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Patients with neurologically derived musculoskeletal deficiencies (NDMD), like spinal cord injury and spina bifida, are high risk for chronic complicated urolithiasis. Recent studies suggest that stone etiology in this population has shifted from purely infectious to mixed infectious/metabolic. We assess a cohort of NDMD patients for metabolic lithogenic risk factors, trends across etiology of NDMD, as well as trends across primary stone type. METHODS We conducted a retrospective cohort study of NDMD patients presenting to our dedicated ′stone clinic′ from 2000-2015. Patients with chemical stone and 24-hour urine analysis were included. Demographics, neurological deficiency, bladder management strategy, urine cultures, 24-hour urine, and stone composition were reviewed. RESULTS Seventy eight patients with NDMD and nephrolithiasis were identified. Of these, 26 had both chemical stone and 24 hour urine analysis. Positive urine cultures prior to treatment were present in 77%. Eighty-five percent of these cultures were positive for urea splitting organisms. The most common stone type categorized by primary composition was carbonate apatite (53.8%) followed by mixed apatite/oxalate (19.2%). When categorized by primary etiology, 61.5% were pure pH dependent (presumed to be infectious), 27% mixed pH dependent/metabolic, and 11.5% pure metabolic. Urinary citrate was significantly lower in patients with carbonate apatite, or pH dependent, calculi. Those with primarily calcium oxalate stones were significantly more likely to be obese (p=0.003), with a mean body mass index of 37. When stratified by gender, males were more likely to have hyperoxaluria. There was a trend toward positive cultures for urea splitting organisms and carbonate apatite stones in catheterized patients. Otherwise, there were no statistically significant differences in 24-hour urine parameters when stratified by gender, neurological deficiency, or bladder management strategy. CONCLUSIONS Among NDMD patients, metabolic factors may play a more significant role in stone formation than previously believed. There is still a high incidence of carbonate apatite stones, which could be attributed to bacteriuria and elevated pH. In addition to this, obesity, low volumes, low citrate, and elevated oxalate suggest a metabolic etiology. Identifying metabolic risk factors in NDMD patients is challenging but important; as it may significantly impact stone recurrence and the need for repeat surgery. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e1290 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Lee Hugar More articles by this author Ilan Kafka More articles by this author Sara Sprauer More articles by this author Michelle Yu More articles by this author Thomas Fuller More articles by this author Hassan Taan More articles by this author Timothy Averch More articles by this author Michelle Semins More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...