1
|
Donati-Bourne J, Kasmani Z, Mohamed WGE, Pillai P, O’Dair J, Bhatt RI. Optimising patients with long-term spinal cord injury for nephrectomy: A review of pre-, peri- and post-operative factors to safeguard outcomes. Journal of Clinical Urology 2021. [DOI: 10.1177/2051415820921089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives: To review the potential challenges a urologist may encounter when embarking on simple/partial/radical nephrectomy in patients with long-term spinal cord injury and propose strategies to pre-empt and manage these. Materials and methods: Comprehensive literature review via PubMed, MEDLINE® and Google™ Scholar searching for relevant scientific articles published to date in English. Recommendations for strategies to safeguard surgical outcomes discussed with a panel of experienced upper-tract urologists. Results: Pre-operative considerations: - urethral assessment via flexible cystoscopy due to higher incidence of urethral pathology in spinal cord injury; - assessing for chronic constipation and distended bowel; and - considering glomerular filtration rate assessment by radio-isotope techniques, such as 51chromium-EDTA Peri-operative considerations: - adequate theatre staffing for safe patient transfer; and - planned choice of incision, due to higher incidence of previous abdominal surgery, stoma bags and/or foreign body devices. Post-operative considerations: - ensuring attending medical staff are trained to recognise autonomic dysreflexia; - early re-mobilisation with physiotherapists experienced in treating spinal cord injury; and - attentive antibiotic stewardship due to higher risk of hospital-acquired or urinary infections Conclusions: Patients with long-term spinal cord injury pose significant potential challenges in the pre-, peri- and post-operative stages of nephrectomy. Familiarisation and optimisation of such factors is recommended to safeguard outcomes. Level of evidence: Not applicable for this multicentre audit.
Collapse
Affiliation(s)
- J Donati-Bourne
- Department of Urology, Shrewsbury and Telford NHS Trust, United Kingdom
| | - Z Kasmani
- Department of Urology, University Hospitals Birmingham NHS Foundation Trust, United Kingdom
| | - WGE Mohamed
- Department of Urology, Shrewsbury and Telford NHS Trust, United Kingdom
| | - P Pillai
- Department of Urology, Shrewsbury and Telford NHS Trust, United Kingdom
| | - J O’Dair
- Department of Urology, Shrewsbury and Telford NHS Trust, United Kingdom
| | - RI Bhatt
- Department of Urology, University Hospitals Birmingham NHS Foundation Trust, United Kingdom
| |
Collapse
|