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Choi, Ku, and Shim: Risk Factors for Urinary Stone Formation in Male Patients with Spinal Cord Injury: A 17-Year Follow-Up Study
Original Article

Korean J Urol 2006;47(8):807-812.

Published online: 18 December 2006

DOI: https://doi.org/10.4111/kju.2006.47.8.807

Risk Factors for Urinary Stone Formation in Male Patients with Spinal Cord Injury: A 17-Year Follow-Up Study

Won Jun Choi, Ja Hyun Ku, Hong Bang Shim

1From the Department of Urology Seoul Veterans Hospital, Seoul, Korea

Corresponding author: Hongbang Shim Department of Urology, Seoul Veterans Hospital 6-2, Dunchon-dong, Gangdong-gu, Seoul ? 134-060 TEL: 02-2225-1393 FAX: 02-487-9586 E-mail: hb0282@daum.net

Received 7 February 2006       Accepted 20 June 2006

Copyright © 2006 The Korean Urological Association

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose:

This study was initiated to establish the hazard ratios for risk of urinary stone formation in chronic spinal cord injury (SCI) patients.

Materials and Methods:

A total of 140 male patients who were injured before 1987 were eligible for this investigation and they were followed up on a yearly basis from January 1987 and December 2003.

Results:

Over the 17 years, 39 patients (27.9%) and 21 patients (15.0%) were diagnosed with bladder and renal stones for a total of 59 and 25 episodes, respectively. On multivariate analysis, bladder stone was more common for the patients who were injured at 24 years old or older than is was for those patients who were injured at less than 24 years old (odds ratio [OR]: 2.490; 95% confidence interval [CI]: 1.092-5.677; p=0.030). In another model, the patients with complete injury had a greater risk of renal stone formation than those with incomplete injury (OR: 4.095; 95% CI: 1.29512.944; p=0.016). We also found that renal stone was more common for the patients with urethral catheterization (UC) than for the patients who could spontaneous void (OR: 5.668; 95% CI: 1.306-24.604; p=0.021), and for patients with bladder stone than for those without bladder stone (OR: 4.678; 95% CI: 1.447-15.126; p=0.010).

Conclusions:

Injury characteristics are important for the development of urinary stone in chronic traumatic SCI patients. In addition, our findings suggest that for the cases who cannot undergo intermittent catheterization or when the bladder cannot empty spontaneously, suprapubic cystostomy is better than UC is regards to renal stone formation in this population. (Korean J Urol 2006;47:807-812)

Keywords: Spinal cord injury, Urinary stone, Risk factors, Catheterization

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Table 1.
Clinical parameters
Parameters SV CIC SPC UC p
No. of patients 47 33 36 24  
Age at injury (yr) 23 (18-40) 23(18-53) 23.5(18-50) 22 (19-39) 0.491†
Age group at injury (yr)         0.254‡
  <24 years (%) 25 (53.2) 21 (63.6) 18 (50.0) 18 (75.0)  
>24 years 22 (46.8) 12 (36.4) 18 (50.0) 6 (25.0)  
  Duration of SCI (yr)∗ 17 (2-35) 19(2-37) 11.5 (1-35) 19 (7-34)
  0.033+        
Duration group of SCI         0.687‡
  <18 years (%) 25 (53.2) 10 (30.3) 24 (66.7) 8 (33.3)  
  ≤18 years (%) 22 (46.8) 23 (69.7) 12 (33.3) 16 (66.7)  
Level of injury         0.659‡
Cervical (%) 15 (31.9) 3 (9.1) 14 (38.9) 7 (29.2)  
Thoracic (%) 24 (51.1) 24 (72.7) 17 (47.2) 13 (54.2)  
Lumbar (%) 8 (17.0) 6 (18.2) 5 (13.9) 4 (16.7)  
Completeness of injury         0.373‡
  Incomplete (%) 34 (72.3) 25 (75.8) 27 (75.0) 20 (83.3)  
  Complete 13 (27.7) 8 (24.2) 9 (25.0) 4 (16.7)  
Mechanism of injury         0.139‡
  Traffic accident (%) 21 (44.7) 14 (42.4) 18 (50.0) 9 (37.5)  
  Fall (%) 18 (38.3) 6(18.2) 11 (30.6) 3 (12.5)  
  Gunshot wound (%) 6(12.8) 10 (30.3) 5 (13.9) 8 (33.3)  
  Others (%) 2 (4.3) 3(9.1) 2 (5.6) 4 (16.7)  

∗years from the injury to the start of the study (1987), † Kruskal-Wallis test, ‡Armitage test. The same letters indicate non-significani differences between groups based on multiple comparison test. Data are presented are medians (range) or numbers (%). SV: spontaneous voiding, CIC: clean intermittent catheterization, SPC: suprapubic cystostomy, UC: urethral catheterization, SCI: spinal cord injury

Table 2.
Incidence of bladder and renal stones according to the bladder management methods
Parameters SV CIC SPC UC
No. of patients 47 33 36 24
Bladder stone
  Accumulated incidence (%) 14 (29.8) 5 (15.2) 15 (41.7)∗ 5 (20.8)
  Incidence (episodes/100 person-years) 2.003 0.891 5.065 1.716
Renal stone
  Accumulated incidence (%) 6(12.8) 3(9.1) 4 (11.1) 8 (33.3)†
  Incidence (episodes/100 person-years) 0.876 0.535 0.654 2.451

∗p<0.05 in the CIC versus the SPC group by the chi-square test. † p < 0.05 in the SV versus the UC group, the CIC versus the UC group, and the SPC versus the UC group by the Fisher's exact test. SV: spontaneous voiding, CIC: clean intermittent catheterization, SPC: suprapubic cystostomy, UC: urethral catheterization

Table 3.
Multivariate risk factors of bladder and renal stones
Parameters Bladder stone Renal stone
Adjusted OR (95% CI) P Adjusted OR (95% CI) P
Age at injury (yr)
  <24 1.000   1.000  
  >24 2.490 (1.092-5.677) 0.030 0.441 (0.132-1.477) 0.184
Duration of SCI (yr)
  ≤18 1.000   1.000  
  >18 2.108 (0.903-4.922) 0.085 0.874 (0.283-2.694) 0.814
Level of injury
  Cervical 1.000   1.000  
  Thoracic 0.809 (0.311-2.102) 0.663 0.548 (0.152-1.971) 0.357
  Lumbar 0.837 (0.234-2.996) 0.785 1.463 (0.325-6.594) 0.620
Completeness of injury
  Incomplete 1.000   1.000  
  Complete 1.361 (0.558-3.319) 0.499 4.095 (1.295-12.944) 0.016
Mechanism of injury
  Traffic accident 1.000   1.000  
  Fall 0.758 (0.288-1.993) 0.574 0.816 (0.221-3.007) 0.759
  Gunshot wound 0.715 (0.221-2.317) 0.576 1.108 (0.263-4.663) 0.888
  Others 1.049 (0.207-5.308) 0.954 0.372 (0.038-3.675) 0.397
Bladder management
  SV 1.000   1.000  
  CIC 0.526 (0.157-1.769) 0.299 0.893 (0.172-4.637) 0.892
  SPC 1.474 (0.560-3.874) 0.432 0.713(0.159-3.191) 0.659
  UC 0.891 (0.244-3.254) 0.861 5.668 (1.306-24.604) 0.021
Bladder stone
  No     1.000  
  Yes     4.678 (1.447-15.126) 0.010
VUR
  No     1.000  
  Yes     1.762 (0.307-10.099) 0.525

OR: odds ratio, CI: confidence interval, SCI: spinal cord injury, SV: spontaneous voiding, CIC: clean intermittent catheterization, SPC: suprapubic cystostomy, UC: urethral catheterization

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