Optimising patients with long-term spinal cord injury for nephrectomy: A review of pre-,peri- and post-operative factors to safeguard outcomes

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.