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CHAPTER 26
Comarr (1955) and Damanski (1962) found renal calculi to be more frequent in
patients with lower motor neuron lesions and also they form more frequently in patients
with complete than with incomplete transverse lesions (Prather, 1947; Bunts, 1959). Age
and long bone fractures are also factors in raising the incidence of calculosis (Rossier &
Bors, 1965). Moreover, according to Bors (1951) and Comarr
el al.
(1962), renal stones
are more prevalent on the right than on the left side in both traumatic paraplegia and
polyomyelitis.
Treatment
In discussing the treatment of calculosis, preventive measures should be mentioned
first. The most important of all these measures in spinal cord injuries is, of course, the
prevention of infection. As shown, this is best achieved by intermittent catheterization
as described earlier in this book, and by transfer of these patients to a Spinal Injuries
Centre immediately or within the first few days after injury. At least as important is the
prevention of stasis of the urine flow due to enforced bed rest and recumbency. The
prevention of crystallization of calcium salts in the kidneys during the stage of hyper-
calciuria in the early weeks after paraplegia by a large fluid intake in correlation to the
number of catheterizations and keeping the urine acid, is also essential. The regular
turning of the patient from the start day
and
night is as essential for the prevention of
stone formation as it is for the prevention of bed sores. When lying in supine position,
the patient, unless he has fractures of the ribs or a haemothorax, should be encouraged
to carry out exercises with a chest expander which increases the blood flow and facilitates
the blood circulation also in the paralysed part of the body. Needless to say, the sooner the
paraplegic and tetraplegic can be raised from the horizontal to the upright position and be
transferred to a wheelchair the better.
Once stones are formed, even small ones, they have little tendency to disappear when
the patient is able to get up, nor can they be dissolved quickly by agents such as solution
G or M (Suby, Suby & Albright, 1942) or Renacedin. If patients are admitted in later
stages with bladder or renal stones of larger size, surgical removal as early as possible
is indicated, as without their removal there is no hope of controlling the infection of the
urinary tract.
Vesical calculi of small or medium size should be crushed under direct vision whenever
possible, and many stones can then be washed out by irrigation. Greatest care and gentle
ness should be exercised in carrying out this operation. Violent suction of the debris
following litholapaxy must be avoided at all cost, as this could result in greater damage,
including rupturing, the already damaged bladder wall or, especially in lesions above T5,
in profound autonomic hyperreflexia, in particular of the cardio-vascular system. Large
bladder stones are best removed suprapubically.
Ureteral stones should be reduced by solutions G or M or in certain instances by
Renacidin so that their extraction by manipulation of the ureteral cather or by a loop
becomes possible. If the ureter stone has caused blockage of urine flow and an acute
hydro- or pyonephrosis has developed, attempts may be successful to push the stone up
into the pelvis and release first the pressure from the kidney which is followed by wash-
