Surgical treatment for urolithiasis in patients with spinal cord injury. II. Clinical comparison of open surgery with ESWL

To evaluate the indications of surgical treatment for urolithiasis in patients with spinal cord injury (SCI), 19 patients on whom we had performed pyelolithotomy and/or ureterolithotomy by the vertical lumbar approach (Gil-Vernet's incision) in the Spinal Injuries Center from 1980 to 1993 were studied retrospectively, as compared with 36 patients without SCI who had undergone ESWL by HM3 (Dornier) in Hara Sanshin Hospital between January and June, 1993. Our results demonstrated that more than 80% of SCI patients with urolithiasis were accompanied by urinary tract infection, with a statistical significance, compared with those without SCI who had undergone ESWL. Furthermore, analysis of the stone component revealed a high incidence of magnesium ammonium phosphate (MAP) in SCI patients with urolithiasis. Surgical treatment by the vertical lumbar approach needed a longer operating time, and longer hospitalization, but a smaller number of operations than ESWL. In addition, residual stones after open surgery were observed in only one case. From these results, less invasive surgical treatment for SCI patients with urolithiasis, such as the vertical lumbar approach, seems to be a useful treatment, especially in specialized hospitals which are not equipped with ESWL.