Dear Colleagues,

Like the spring weather, Urotoday International Journal boasts its own mix of interesting and unpredictable articles of note that are sure to engage and interest our readers. We are proud of the encouraging variety of submissions and the discussion they will create in the days, weeks, and months ahead.

Singh et al. assessed the effectiveness of using intravesical prostatic protrusion (IPP) in correctly predicting bladder outlet obstruction (BOO) in symptomatic patients with BPH. In these patients, they compared IPP with other parameters of BOO like prostate volume, bladder wall thickness, PVR, and uroflowmetry. They conclude that bladder wall thickness and post-void residue in conjunction with IPP are good predictors of clinically significant BOO due to BPH.

Khan and colleagues discuss the incidence of immediate graft function (IGF), identify events causing delayed graft function (DGF), slow graft function, and factors that promote IGF in our living donor transplant recipients using kidneys recovered exclusively by open donor nephrectomy (ODN). They conclude that ODN is associated with excellent IGF and recommend it.

Nath et al. aim at determining the role of testosterone as a lithogenic factor and its relation to urinary and stone components. They found higher serum-free and total testosterone, and 24 hours of urinary oxalate  in male stone formers compared to non-stone formers. A larger prospective study is necessary to establish testosterone as a lithogenic factor in male former-stone patients.

The team of Falahatkar et al. compares complications and outcomes of totally ultrasonic versus fluoroscopically guided complete supine percutaneous nephrolithotomy (csPCNL). Through their findings, they demonstrate that totally ultrasonic had similar outcomes to fluoroscopic csPCNL in selected cases and conclude that ultrasonography can be an alternative to fluoroscopy in csPCNL.

Al-Asali and team assess if the AJUST® SIS would be an effective alternative to the TOT in a cohort of patients who have urodynamic stress incontinence with concomitant detrusor overactivity, voiding difficulty, high BMI, or those with previous retropubic surgery. Mean postoperative pain scores were low with no de novo groin pain. All women had satisfactory postoperative voiding and a negative cough stress test at 6 weeks of follow-up. At the 2-year follow-up, 89% had still improved.

Finally, Draga et al. present a study that investigates the accuracy of reproducing bladder coordinates during transurethral resection using an optical navigation system, as a first step to assess the feasibility of accurate navigation-assisted resection of bladder tumors. They show that navigation-assisted mapping of the bladder is accurate with constant bladder volumes.

We also present a series of case studies on several topics, including idiopathic urethral strictures, late bladder erosion complications, and primary vulval tuberculosis.  

As always, we are grateful to our sustained readership, our devoted authors, and our hard-working editorial board that continues to work tirelessly to make UIJ a distinguished journal in the field. 

Sincerely,

Karl-Erik Andersson

ABSTRACT

We present a case of 2 patients with late bladder erosion and vesical stone formation due to mesh erosion from mid-urethral polypropylene slings and their management. Patients presented 18 and 22 months after surgery with hematuria, recurrent urinary tract infections, and lower urinary tract symptoms. Stone fragmentation was done by pneumatic lithotripsy, and transurethral resection of the mesh was performed using a 26 Fr resectoscope. Postoperative control cystoscopy demonstrated complete healing of bladder mucosa after 3 months. The patients were satisfied with this result, and the patients reported significant improvement of symptoms. The patients remained completely continent at the follow-up period. The endoscopic management of the eroded mesh should be the first choice of bladder erosion therapy. Careful and comprehensive urethrocystoscopy is mandatory during a mid-urethral sling procedure. There is a need for long-term follow-up of patients with mid-urethral slings. We present a case of 2 patients with late bladder erosion and vesical stone formation due to mesh erosion from mid-urethral polypropylene slings and their management. Patients presented 18 and 22 months after surgery with hematuria, recurrent urinary tract infections, and lower urinary tract symptoms. Stone fragmentation was done by pneumatic lithotripsy, and transurethral resection of the mesh was performed using a 26 Fr resectoscope. Postoperative control cystoscopy demonstrated complete healing of bladder mucosa after 3 months. The patients were satisfied with this result, and the patients reported significant improvement of symptoms. The patients remained completely continent at the follow-up period. The endoscopic management of the eroded mesh should be the first choice of bladder erosion therapy. Careful and comprehensive urethrocystoscopy is mandatory during a mid-urethral sling procedure. There is a need for long-term follow-up of patients with mid-urethral slings. 

Emrah Okulu, Kemal Ener, Mustafa Aldemir, Onder Kayigil

Submitted March 21, 2013 - Accepted for Publication April 22, 2013

KEYWORDS: Bladder erosion, incontinence surgery, vesical stone

CORRESPONDENCE: Emrah Okulu, M.D., Umit Mh. Meksika Cd. 2463. sk. 4/32, Umitköy, Yenimahalle, Ankara, Turkey ()

CITATION: UroToday Int J. 2013 June;6(3):art 41. http://dx.doi.org/10.3834/uij.1944-5784.2013.06.15

ABSTRACT

Introduction: Urolithiasis typically affects adult men more commonly than women with a two- to threefold higher incidence. Stone disease has been found to have an inverse relationship as one ages. This gender and age differentiation invites the role of testosterone as a possible lithogenic factor. Our study aims at determining the role of testosterone as lithogenic factor and its relation to urinary and stone components.

Methods: A total of 87 men older than 18 years were enrolled in our study. Early morning free and total testosterone, serum level of the parathyroid hormone, calcium acid, and uric acid were estimated between the 2 groups. Twenty-four hours of urinary oxalate, uric acid, and calcium were estimated in all patients and the control. Stone analysis was done to determine stone composition for stones in the former group.

Results: Of the 87 patients, 48 patients had a history of urolithiasis and 39 patients had no history of urolithiasis. In comparison to non-stone formers, stone formers have higher serum-free and total testosterone, and 24-hour urinary oxalate. A positive and weak-positive correlation was found in relation to 24 hours of urinary oxalate for free and total testosterone, respectively. Calcium oxalate stones were found in 40 patients. Other differences between the 2 groups were not statistically significant.

Conclusions: A higher serum-free and total testosterone, and 24 hours of urinary oxalate were found in male stone formers compared to non-stone formers. Serum testosterone had a positive correlation to urinary oxalate. These findings have a similarity with animal and human studies. A larger prospective study is necessary to establish testosterone as a lithogenic factor in male former-stone patients.

Simanta Jyoti Nath, Debanga Sarma, Puskal K. Bagchi, Sasanka K. Baruah, Rajeev T. Puthenveetil, Saumar J. Baruah

Submitted February 25, 2013 - Accepted for Publication May 12, 2013

KEYWORDS: Serum testosterone, urinary oxalate, calcium oxalate stones

CORRESPONDENCE: Dr. Simanta Jyoti Nath, Department of Urology, Gauhati Medical College & Hospital, Bhangagarh, Guwahati, PIN-78100, Assam, India, ()

CITATION: UroToday Int J. 2013 June;6(3):art 37. http://dx.doi.org/10.3834/uij.1944-5784.2013.06.11

ABSTRACT

Primary tuberculosis (TB) of the vulva is very rare. Here we report a case of primary ulcerative vulvar TB. The diagnosis was made on the histopathological finding along with demonstration of acid-fast bacilli on tissue biopsy and managed with anti-tubercular drugs. So, tuberculosis should be suspected in cases of non-healing vulvar ulcers, particularly in developing countries.

Krishnendu Maiti, Shwetank Mishra, Malay Bera, Dilip Pal, Moumita Maiti, Partha Pratim Mondal

Submitted February 27, 2013 - Accepted for Publication May 10, 2013

KEYWORDS: Vulva, tuberculosis, non-healing, ulcers

CORRESPONDENCE: Shwetank Mishra, Department of Urology, Institute of Postgraduate Medical Education & Research, Kolkata, India ()

CITATION: UroToday Int J. 2013 June;6(3):art 39. http://dx.doi.org/10.3834/uij.1944-5784.2013.06.13

ABSTRACT

Aim: To prospectively detect clinically significant bladder outlet obstruction (BOO) in all symptomatic patients presenting with lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH) by studying select parameters like prostate volume, bladder wall thickness (BWT), intravesical prostatic protrusion (IPP), post-void residue (PVR), and uroflowmetry. Our aim is also to determine the effectiveness of using IPP in correctly predicting BOO in symptomatic patients with BPH, and to compare IPP with other parameters of BOO like prostate volume, bladder wall thickness, PVR, and uroflowmetry in patients with symptomatic BPH.

Methods: After obtaining institutional ethical clearance for this study and administering an informed consent, history, focused urological examination, and International Prostate Symptom Score (IPSS), select ultrasonographic and uroflowmetry parameters were recorded and analyzed in 48 selected patients, as per our protocol.

Results: The mean BWT, PVR, and IPP were 6.26 mm, 91.27 cc, and 8.2 mm, respectively, and their mean maximal flow rate (MFR), average flow rate (AVR), voiding duration, acceleration, and hesitancy time in 44/48 evaluable patients (4 patients had AUR) were 13.68 (3 to 49) mL/min, 7.17 (2 to 25) mL/min, 49.12 (15 to 115) secs, 3.82 (0 to 70) secs, and 13.9 (1 to 242) secs, respectively. The paired sample test (2-tailed) analysis demonstrated that the relationship between BWT vs MFR, IPP (mm) vs MFR, PVR vs MFR, and AFR was highly significant (P < 0.001).

Conclusion: With increasing life expectancy, more men are destined to develop bothersome symptoms due to BPH. Bladder wall thickness and post-void residue in conjunction with intravesical prostatic protrusion are good predictors of clinically significant bladder outlet obstruction due to BPH. A search for more reliable, accurate, and non-invasive methods could substitute present methods of evaluating symptomatic BOO due to BPH.

Iqbal Singh, Shankar Kumar

Submitted February 27, 2013 - Accepted for Publication May 10, 2013

KEYWORDS: BPH, bladder outlet obstruction, bladder wall thickness, post-void residue, intravesical prostatic protrusion

CORRESPONDENCE: Dr. Iqbal Singh, MCh (Urology), DNB (GU Surgery), MS, DNB (Surgery), Professor & Senior Consultant Urologist, Department of Surgery (Urology), University College of Medical Sciences, New Delhi, India ()

CITATION: UroToday Int J. 2013 June;6(3):art 40. http://dx.doi.org/10.3834/uij.1944-5784.2013.06.14

ABSTRACT

Ganglioneuromas are neurogenic tumors that often stem from sympathetic ganglion cells, and less frequently from the adrenal medulla and peripheral nerves. These tumors are slow-growing and have a more benign character compared to other cell types. Herein we present a pure ganglioneuroma of a 50-year-old male patient as the third case reported in the urinary bladder. At cystoscopy a 6 cm x 6 cm tumor was found on the posterior wall of the bladder and resected. Histologically, the tumor was composed of mature and immature ganglion cells and Schwann cells. Since the neuroblasts did not consist of an evident bundle structure, it was diagnosed as a ganglioneuroma. To our knowledge, 5 cases of composite paraganglioma-ganglioneuroma have been reported in the English literature. However, there are only 2 documented cases of bladder-located, pure ganglioneuromas. 

Kemal Ener, Mustafa Aldemir, Emrah Okulu, Aylin Kilic Yazgan, Murat Keske, Fatih Akdemir, Muhammet Fuat Özcan

Submitted April 1, 2013 - Accepted for Publication May 17, 2013

KEYWORDS: Ganglioneuroma, urinary bladder

CORRESPONDENCE: Dr. Kemal Ener, Ataturk Education and Research Hospital Urology Clinic, 06610, Ankara, Türkiye ()

CITATION: UroToday Int J. 2013 June;6(3):art 38. http://dx.doi.org/10.3834/uij.1944-5784.2013.06.12

ABSTRACT

Introduction: The mid-urethral sling has become the mainstay in the surgical management of stress urinary incontinence. Early meta-analyses suggested that the obturator approach (TOT) may be preferable in women with a high body mass index (BMI), concomitant voiding difficulties (VD), mixed urinary incontinence (MUI), or previous retropubic surgery. However, they are associated with increased and prolonged de novo groin pain. The AJUST® single-incision sling (SIS) was developed as an alternative to the retropubic and obturator slings and has been shown to be an effective treatment for urodynamic stress incontinence (USI) in the short term. We aim to assess if the AJUST® SIS would be an effective alternative to the TOT in a cohort of patients who have urodynamic stress incontinence (USI) with concomitant detrusor overactivity (DO), VD, high BMI, or those with previous retropubic surgery.

Methods: Women with USI and either concomitant DO, VD, previous failed TVT, or a BMI > 35 underwent treatment with the AJUST® SIS. Women were asked to complete the International Consultation on Incontinence Questionnaire-Urinary Incontinence-Short Form (ICIQ-UI-SF) and an Urgency Perception Scale (UPS) preoperatively and then at 6 weeks, 6 months, 12 months, and 24 months postoperatively along with the PGI-I form. The numerical rating scale (NRS) was used to score pain 3 hours postoperatively and prior to discharge. Changes in ICIQ-UI-SF and UPS scores were measured.

Results: Twenty-five women were recruited. The mean age was 58 years. Of these, 28% had USI and 72% had mixed incontinence. There were no major perioperative complications. Mean postoperative pain scores were low with no de novo groin pain. All women had satisfactory postoperative voiding and a negative cough stress test at 6 weeks of follow-up. At the 2-year follow-up, 89% had still improved.

Conclusion: The AJUST® SIS appears to have promising medium-term efficacy in this challenging cohort of women. The long-term results are awaited.

Fida Al-Asali, Alexander Goodman, Ismaiel Abu Mahfouz, Christian Phillips

Submitted April 2, 2013 - Accepted for Publication April 24, 2013

KEYWORDS: Stress urinary incontinence, retropubic sling, transobturator sling, AJUST® sling

CORRESPONDENCE: Ismaiel Abu Mahfouz, Consultant Obstetrician and Gynecologist, Jordan Healthcare Center, Amman, Jordan ()

CITATION: UroToday Int J. 2013 June;6(3):art 36. http://dx.doi.org/10.3834/uij.1944-5784.2013.06.10

ABSTRACT

Introduction: Surgical navigation systems have proven to support surgeons to localize and target anatomical structures. The aim of this study is to investigate the accuracy of reproducing bladder coordinates during transurethral resection using an optical navigation system, as a first step to assess the feasibility of accurate navigation-assisted resection of bladder tumors.

Methods: The coordinates of 21 bladder locations in 7 patients were collected using a Medtronic StealthStation Surgical Navigation System with infrared optical tracking. The coordinates of bladder lesions and ureteral orifices were recorded twice, independently, after filling the bladder with an arbitrary fixed volume of 390 mL of saline.

Results: The distance, in millimeters, between the coordinates of 2 consecutive measurements of the same bladder location was calculated. Bladder lesions and ureteral orifices could be retrieved with a mean accuracy of 8.2 mm (SD = 6.2; N = 21).

Conclusion: Navigation-assisted mapping of the bladder showed to be accurate at constant bladder volumes. Further development of the technology is needed to improve navigation efficiency and to implement augmented reality techniques to facilitate the retrieval of bladder tumors during transurethral resection.

Ronald O.P. Draga, Herke Jan Noordmans, Tycho M.T.W. Lock, Joris Jaspers, Arjen van Rhijn, J.L.H. Ruud Bosch

Submitted February 21, 2013 - Accepted for Publication April 24, 2013

KEYWORDS: Urinary bladder neoplasms, computer-assisted surgery, cystoscopy, residual neoplasm, recurrence

CORRESPONDENCE: Ronald Oskar Draga, M.D., Department of Urology, University Medical Center, Utrecht, Utrecht, Netherlands ()

CITATION: UroToday Int J. 2013 June;6(3):art 35. http://dx.doi.org/10.3834/uij.1944-5784.2013.06.09

ABSTRACT

We report the first case of Burkholderia cepacia infection leading to multiple kidney abscesses and concomitant prostatic abscess in a human immunodeficiency virus (HIV)-positive 21-year-old male. The patient initially presented with generalized abdominal pain, and computed tomography (CT) demonstrated left renal micro-abscesses. A follow-up CT scan demonstrated worsening of the kidney abscesses and a cystic lesion in the right prostate gland suggestive of an abscess. Transrectal ultrasound guided drainage of the abscess was followed by transurethral resection of the prostatic abscess. All clinicians need vigilance and an open-mind when investigating etiologies for infectious disease processes in HIV-positive patients. 

Zachary Klaassen, Young Kwak, Derrick L. Johnston, Jeffrey M. Donohoe, Martha K. Terris

Submitted January 28, 2013 - Accepted for Publication April 22, 2013

KEYWORDS: Burkholderia cepacia, granulomatous prostatitis, HIV, kidney abscess, prostate abscess

CORRESPONDENCE: Zachary Klaassen, M. D., Department of Surgery, Section of Urology, Medical College of Georgia, Georgia Regents University, 1120 15th Street, Augusta, Georgia 30912 ()

CITATION: UroToday Int J. 2013 June;6(3):art 34. http://dx.doi.org/10.3834/uij.1944-5784.2013.06.08

ABSTRACT

Introduction: To compare complications and outcomes of totally ultrasonic versus fluoroscopically guided complete supine percutaneous nephrolithotomy (csPCNL).

Materials and Methods: In this randomized clinical trial study from January 2009 to September 2010, 26 of 51 patients with renal stones underwent csPCNL with ultrasonographic guidance (group A), and the other 25 patients underwent fluoroscopically guided csPCNL (group B). Statistical analysis was performed with SPSS 16 software.

Results: The mean BMI was 28.14 in group A and 26.31 in group B (ρ = 0.30). The mean stone burden was 26.48 and 30.44 in groups A and B, respectively (ρ = 0.20). The stone-free rate was 88.5% and 75.5% in groups A and B, respectively (ρ = 0.16). Overall, 2 patients (7.7%) in group A and 6 patients (24%) in group B had complications (ρ = 0.11). The mean operative time in groups A and B were 88.46 and 79.58 minutes, respectively (ρ = 0.39). The mean hospital stay was 69.70 and 61.79 hours in groups A and B, respectively (ρ = 0.22).

Conclusion: Totally ultrasonic had similar outcomes to fluoroscopic csPCNL in selected cases. Ultrasonography can be an alternative to fluoroscopy in csPCNL.

Siavash Falahatkar, Aliakbar Allahkhah, Majid Kazemzadeh, Ahmad Enshaei, Maryam Shakiba, Fahimeh Moghaddas, Mohammad Allahkhah

Submitted March 27, 2013 - Accepted for Publication May 5, 2013 

KEYWORDS: Percutaneous nephrolithotomy, supine, ultrasound, fluoroscopy, complete supine, csPCNL

CORRESPONDENCE: Aliakbar Allahkhah, M.D., Urology Research Center, Guilan University of Medical Sciences, Rasht, Guilan, Islamic Republic of Iran ()

CITATION: UroToday Int J. 2013 June;6(3):art 33. http://dx.doi.org/10.3834/uij.1944-5784.2013.06.07

ABSTRACT

Pediatric urethral narrowing or idiopathic etiology of a stricture is difficult to suspect in the absence of classic obstructive lower urinary tract symptoms. It is still unclear whether it should be defined as congenital stricture because of an absence of a clear-cut traumatic history; one cannot rule out unnoticed trauma in walking kids. We present a similar case in a child, managed with a modified conventional graft urethroplasty technique. 

Adittya K. Sharma, N. H. Nagaraja, J. Srinivas, G. K. Venkatesh

Submitted February 19, 2013 - Accepted for Publication April 28, 2013

KEYWORDS: Pediatric urethral stricture, congenital urethral stricture, Buccal graft urethroplasty

CORRESPONDENCE: Adittya K. Sharma, Department of Urology, Institute of Nephro-Urology, Victoria Hospital Campus, Bangalore, Karnataka ()

CITATION: UroToday Int J. 2013 June;6(3):art 32. http://dx.doi.org/10.3834/uij.1944-5784.2013.06.06

ABSTRACT

Dysgerminomas are the most common malignant germ-cell tumor of the ovary, which are usually locally invasive and metastasize to regional lymph nodes. Metastases to the kidney are quite rare, occur in disseminated disease, and there are only a few reports in literature. We report a case of ovarian dysgerminoma metastasizing to the ipsilateral kidney in a 24-year-old female. 

Vinod Priyadarshi, Kaushik Sarkar, Jitendra Pratap Singh, Rajesh Loonia, Debashish Chakrabarty, Dilip Kumar Pal

Submitted February 25, 2013 - Accepted for Publication April 28, 2013

KEYWORDS: Dysgerminoma, metastasis, kidney, ovary

CORRESPONDENCE: Vinod Priyadarshi, MCh (std) and Resident, Department of Urology, Institute of Post Graduate Medical Education and Training, Kolkata, West Bengal, India ()

CITATION: UroToday Int J. 2013 June;6(3):art 31. http://dx.doi.org/10.3834/uij.1944-5784.2013.06.05

ABSTRACT

Purpose: To determine the incidence of immediate graft function (IGF), identify events causing delayed graft function (DGF), slow graft function (SGF), and factors that promoted IGF in our living donor transplant recipients using kidneys recovered exclusively by open donor nephrectomy (ODN).

Methods: We performed a recipient- and donor-database analysis after approval from our institutional review board.

Results: Out of 211 recipients, IGF was established in 99.2%, a prolonged recipient warm ischemia time (RWIT) of 112 minutes and severe hypoxia caused DGF (0.4%) and SGF (0.4%), respectively, in 2 recipients. Five grafts were lost, including 3 recipients who died with functioning grafts. A mean 42-month graft survival was 98% in the IGF group and 100% in the poor early graft function (PEGF) group, and small numbers in the PEGF group prevented statistical analysis. The presence of diabetes, black recipients, RWIT of ± 60 minutes, donor warm ischemia time (WIT) of ±5 minutes, multiple arteries, obesity, sensitization, re-transplantation, right kidneys, and female donors did not predispose to PEGF.

Conclusion: We found ODN to be associated with excellent IGF and recommend it. We also recommend minimizing the impact of procedural factors with meticulous vascular anastomoses to reduce RWIT, antithymocyte globulin induction (ATG) to avoid calcineurin inhibitor (CNI) nephrotoxicity, cold histidine-tryptophan-ketoglutarate (HTK) perfusion to reduce cellular injury, and maintain optimal oxygenation and filling pressures in the donor and recipient.

Taqi F Toufeeq Khan, Mohammad T Said, Suhaib Kamal, Faheem Akhter, Zakariya Al-Salam

Submitted January 28, 2013 - Accepted for Publication April 22, 2013

KEYWORDS: Living donor kidney transplant, open donor nephrectomy, immediate graft function, poor early graft function, warm ischemia, cold ischemia

CORRESPONDENCE: Taqi F Toufeeq Kahn, Department of Surgery, PO Box 7897/624N, Riyadh Military Hospital, Riyadh, 11159, Saudi Arabia ()

CITATION: UroToday Int J. 2013 June;6(3):art 30. http://dx.doi.org/10.3834/uij.1944-5784.2013.06.04

ABSTRACT

We report a rare case of idiopathic ureteric stricture. Ureteric strictures usually occur following infective, ischemic malignant etiology or external compression with an incidence around 10% [1]. Idiopathic ureteric stricture is extremely rare.

Raman Tanwar, Sudhir Kumar Jain

Submitted March 12, 2013 - Accepted for Publication April 1, 2013

KEYWORDS: Idiopathic ureteric fibrosis, stricture, ureteric stricture

CORRESPONDENCE: Raman Tanwar, MS, Maulana Azad Medical College, Bahadur Shah Zafar Marg, New Delhi, Delhi, India ()

CITATION: UroToday Int J. 2013 June;6(3):art 29. http://dx.doi.org/10.3834/uij.1944-5784.2013.06.03

ABSTRACT

A 22-year-old female presented with symptomatic primary ureteropelvic junction (UPJ) obstruction of the right renal moiety in a horseshoe kidney. She was managed via right retroperitoneoscopic dismembered pyeloplasty. The patient is doing well in 2 years of follow-up. A review of the literature revealed 24 cases of transperitoneal laparoscopic pyeloplasty done for UPJ obstruction in a horseshoe kidney. Of these, only 1 case was approached with anterior extraperitoneal techniques for the kidney. Herein, we report the first right retroperitoneoscopic dismembered pyeloplasty, performed using 3 ports described for classic retroperitoneoscopy.

Vishwajeet Singh, Dheeraj Kumar Gupta, Rahul Janak Sinha

Submitted February 4, 2013 - Accepted for Publication March 25, 2013

KEYWORDS: Retroperitoneoscopy, dismembered, pyeloplasty, horseshoe kidney, UPJ obstruction

CORRESPONDENCE: Vishwajeet Singh, MS.,MCh (Urology), Chhatrapati Shahuji Maharaj Medical University (Formerly KGMC), Lucknow, Uttar Pradesh, India ()

CITATION: UroToday Int J. 2013 June;6(3):art 28. http://dx.doi.org/10.3834/uij.1944-5784.2013.06.02

ABSTRACT

We present a case report of a seizure and neurological deficit following percutaneous nephrolithotripsy (PCNL) due to a venous air embolism in a patient who was previously healthy and not suffering from any intracardiac defects (foramen ovale) or prepulmonary AV shunts. An air pyelogram has the potential risk of an air embolism, and the time of seizure onset and neurological deficit following the procedure may be the clue to the path followed by air emboli. In our case, the time of seizure onset and neurological deficit following the procedure was 10 hours, and the volume of air injected exceeded the recommended dose (10 to 15 ml). The clinical diagnosis of venous air embolism was confirmed by magnetic resonance imaging (MRI). To our knowledge, this is the first reported case of such a complication.

Mufti Mahmood Ahmed, Zahid Mohd Rather, Bashir Ahmed Sanai, Nazir Ahmad Salroo, Riyaz Munawar Wani, Imran Nazir Salroo

Submitted February 1, 2013 - Accepted for Publication March 25, 2013

KEYWORDS: Renal stones, PCNL, air embolism, seizures

CORRESPONDENCE: Mufti Mahmood Ahmed (MCh), Assistant Professor and Chief Urologist, Division of Urology, Department of Surgery, Government Medical College, Srinagar, Jammu and Kashmir, India ()

CITATION: UroToday Int J. 2013 June;6(3):art 1. http://dx.doi.org/10.3834/uij.1944-5784.2013.06.01