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.

Suprome percutaneous nephrolithotomy, is it really effective? A systematic review of literature

This systematic review was performed to determine the clinical value of percutaneous nephrolithotomy in the supine position in comparison with the convention of performing the procedure in the prone position. A systematic review of the medical literature was conducted searching for studies on percutaneous nephrolithotomy in the supine position, limited to publications appeared in the PubMed between 1980 and July 2008. Non-English articles were considered if deemed relevant by providing additional data. In the retrieved articles, reference lists were hand-searched to identify additional relevant articles. There were 9 original articles on percutaneous nephrolithotomy in the supine position. Five studies were retrospective and 4 were prospective, of which only 1 was a well-designed randomized controlled trial published in 2008. The success rate of the procedure was reported between 69.6% and 95%. The risk of requiring blood transfusion was between zero and 8%. Duration of hospital stay was variable, but generally less than that in the prone position. No colon perforation was reported. In carefully selected patients with uncomplicated urinary calculi, percutaneous calculus removal in the supine position can yield similar outcomes to that in the prone position