Korean J Urol.  2013 Mar;54(3):172-176.

Neurologic Complications in Percutaneous Nephrolithotomy

• Basiri A
• Soltani MH
• Kamranmanesh M
• Tabibi A
• Mohsen Ziaee SA
• Nouralizadeh A
• Sharifiaghdas F
• Poorzamani M
• Gharaei B
• Ozhand A
• Lashay A
• Ahanian A
• Aminsharifi A
• Sichani MM
• Asl-Zare M
• Ali Beigi
• Najjaran V
• Abedinzadeh M
• Nikkar MM

Abstract

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.

Keyword

Complications; Nephrolithotomy; Neurologic deficits; Paraplegia

MeSH Terms

Anesthesia, General
Coma
Hemiplegia
Humans
Iran
Medical Records
Nephrostomy, Percutaneous
Neurologic Manifestations
Paraplegia
Prone Position
Retrospective Studies

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