Extracorporeal shock wave lithotripsy on patients with spinal cord injury with special reference to autonomic hyperreflexia

: We performed treatment of urolithiasis on 7 patients with spinal cord injury (6 males and one female, with a mean age of 41 years old) by extracorporeal shock wave lithotripsy (ESWL) using a Lithostar (Siemens). The level of injury was cervical in 3 patients and lower thoracic in 4. The treated stones were renal in 6 patients, including one staghorn caliculus, ureteral in 2, and bladder stones in 2 patients. ESWL was performed under general anesthesia in 2 patients, and in another patient, epidural anaesthesia was employed in the first several sessions, but thereafter treatment was safely continued with no anesthesia. The other 4 patients were treated without anesthesia. In most patients, the stones (9 stones in 6 cases) were easily disintegrated after treatment of from one to 14 sessions, except one case of staghorn caliculus, and the clearance of fragments was also satisfactory. In one patient, hypertension and bradycardia due to autonomic hyperreflexia were observed during ESWL, and the treatment was discontinued, but the stone was successfully disintegrated and the fragments were voided. In another patient, autonomic hyperreflexia was observed while the fragments passed through the ureter, although no signs of this reflexia were seen during the ESWL procedure.