Urinary tract status of patients with neurogenic dysfunction presenting with upper tract stone disease.

We treated 71 patients with neurogenic vesical dysfunction between September 1983 and June 1990 for upper tract stones. We studied these patients to determine the time course of stone development and the presence of associated urological abnormalities. There were 44 male and 27 female patients 6 to 72 years old. Lower urinary tract dysfunction resulted from spinal cord injuries in 34 patients (48%), myelodysplasia in 19 (27%), multiple sclerosis in 12 (17%) and other diagnoses in 6 (8%). Of 71 patients 21 (30%) were managed by an ileal loop, 12 (17%) by a Foley catheter, 10 (14%) by a suprapubic tube, 10 (14%) by ureterostomy, 5 (7%) by vesicostomy, 8 (11%) by intermittent catheterization, and 5 (7%) by diaper, Créde's voiding or condom catheterization. Stone disease developed within 1 to 22 years. Patients with an indwelling catheter or supravesical diversion fared worse than those managed by intermittent catheterization or vesicostomy; they had higher rates of renal unit loss, renal parenchymal damage, decreased renal function, hydroureter, and staghorn and bilateral calculi. All of the listed methods of management were contemporaneous, suggesting the continued use of methods proved to be associated with upper tract deterioration.