Neurologic Complications in Percutaneous Nephrolithotomy

PURPOSE: Percutaneous nephrolithotomy (PCNL) has been the preferred procedure for the removal of large renal stones in Iran since 1990. Recently, we encountered a series of devastating neurologic complications during PCNL, including paraplegia and hemiplegia. There are several reports of neurologic complications following PCNL owing to paradoxical air emboli, but there are no reports of paraplegia following PCNL. MATERIALS AND METHODS: We retrospectively reviewed the medical records of patients who had undergone PCNL in 13 different endourologic centers and retrieved data related to neurologic complications after PCNL, including coma, paraplegia, hemiplegia, and quadriplegia. RESULTS: The total number of PCNL procedures in these 13 centers was 30,666. Among these procedures, 11 cases were complicated by neurologic events, and four of these cases experienced paraplegia. All events happened with the patient in the prone position with the use of general anesthesia and in the presence of air injection. There were no reports of neurologic complications in PCNL procedures performed with the patient under general anesthesia and in the prone position and with contrast injection. CONCLUSIONS: It can be assumed that using room air to opacify the collecting system played a major role in the occurrence of these complications. Likewise, the prone position and general anesthesia may predispose to these events in the presence of air injection.

Evaluation of the Raphanus sativus effect on urinary pH

According to urology texts, urinary calculi are the third most common affliction of the urinary tract and they pose great expenses on health services. The use of oral herbal medication is one of the cheapest ways of treating this disease [in some societies black radish plant is used as a treatment]. The scientific term for black radish is Raphanus sativus nigra. Urinary pH is a prominent factor in any crystallization process in urine. This study was conducted to determine the possible effects of Raphanus on urinary pH as a factor in stone formation and crystallization. Thirty healthy people including 11 males and 19 females without any history of drug consumption or urinary calculi in their first degree relatives were chosen and underwent a four days trial. The experiment included 2 days of Raphanus juice consumption during which urinary pH was measured 4 times a day. The averages of Urinary pH with or without Raphanus juice consumption were compared by t-paired test. The Study was carried out using 30 participants including 11 males and 19 females with the mean +/- SD age of 28.66 +/- 10.8 [range 19-55]. Out of the eight pairs of urinary pH, only in two pairs P values were 0.05 and 0.028 and the rest were all greater than 0.05 which is not sufficient to show a significant difference between urinary pH with or without Raphanus juice consumption. In this study, the effect of Raphanus sativus nigra on urinary pH was not proved. However, according to the proved effects of Raphanus as a diuretic and dissolution agent in Rats, it would be reasonable to repeat the same study in a human population