Air Embolism Following Percutaneous Nephrolithotripsy: An Unusual Complication


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.


Letter from the Editor - April 2013

Dear Colleagues,

It’s April again and we are welcomed by the rebirth of spring. With that comes potential, and we at UIJ know there are new ideas, innovations, and studies out there that authors are hoping to share. We encourage our current readers and authors to continue to spread the good word about UIJ, reminding potential submitters that submission, peer review, and publication are all free.

We would also like to welcome Anna Forsberg as the new editorial assistant on the UIJ. We are sure you will find her to be helpful as well as patient.  

In this issue, Pal et al. present a study performed to establish the efficacy of tacrolimus ointment as a mode of nonsurgical management of early balanitis xerotica obliterans. They show that the use of topical tacrolimus has promising results with good symptomatic relief and few side effects.

Singh et al. compare the clinical efficacy and tolerability of naftopidil versus tamsulosin in patients with lower urinary tract disorders due to benign prostatic hyperplasia. Tamsulosin acts via α1A/D-receptors and naftopidil mainly via α1D-receptors. Despite this difference, they find  that in the management of symptomatic BPH, naftopidil and tamsulosin appeared to be equally effective, safe, and well tolerated.

McCammon et al. performed a retrospective review of urodynamic findings in patients presenting to their institution with post-prostatectomy incontinence following either an open or robotic prostatectomy from 1985 through 2009. They found that following open compared to robotic prostatectomy, patients experienced elevated voiding pressures and decreased peak flows, presumably secondary to the increased incidence of anastomotic stenosis observed in those patients.

Daneshmand et al. attempt to evaluate the relationship and investigate the short-term effects of continent and non-continent diversions on patients with both normal renal function and pre-existing renal insufficiency. Their study suggests that mild pre-existing renal insufficiency may not be a contraindication to continent diversion.

A study by Wani et al. aimed to evaluate the incidence of von Hippel-Lindau (VHL) gene mutations among a group of Kashmiri patients diagnosed with renal cell tumors. They demonstrated that alteration in the VHL gene had been implicated in the pathogenesis of renal-cell sporadic cancer of the patients in their population.

The aim of a study by Swellam et al. was to evaluate the feasibility of tattooing of the bladder urothelium using different stains. Despite the side effects of the used materials, tattooing remains feasible. A wide range of dyes and pigments can be used, however, the type of material, dose titration, and long follow-up are needed to detect the most suitable material.

We also present a series of case studies on several topics, including disorders of sexual differentiation, a giant capsular leiomyoma of the kidney, and a large staghorn calculus.

As always, we are grateful to our continued readership for their loyalty, and I thank our editorial board for their dedication and commitment to quality with every article we publish. 

Warm regards, 

Karl-Erik Andersson

Bladder Tattooing in the Urological Armamentarium: An Experimental Study


Objective: To evaluate the feasibility of tattooing of the bladder urothelium using different stains.

Methods: The study was performed on 20 healthy male and female dogs, which were divided into 4 groups according to the injected material. The first group (4 animals) was injected with hydrated iron (II) sulphate. The second group (4 animals) was injected with methylene blue added to hydrated iron (II) sulphate. The third group (8 animals) was injected with India ink, and the fourth group (4 animals) was injected with methylene blue. The procedure was performed under general anesthesia. The doses as well as the injection technique were standardized. Re-exploration with sacrifice of the dogs was performed after 40 days. The bladder was examined grossly for dye retention. Bladder, spleen, and liver specimens were sent for histopathological examination.

Results: Tattooing was performed successfully without any immediate reaction. Postoperative complications occurred in a single case in the form of vesicocutaneous fistula. At re-exploration, the dye was retained in both the first and second groups, and there was no difference in color intensity. Methylene blue increased the local inflammatory changes. The third and the fourth groups failed to retain the dye. Local reaction at the site of injection, as well as in the bladder, was present in all cases, being most severe in the third group. In cases of the first, second, and third groups the inflammatory reaction involved the liver with hepatic degeneration up to cirrhotic changes. Histopathological examination showed the presence of ferrous particles in the submucosa as well in the detrusor muscles. The presence of ferrous particles was also detected in the spleen.

Conclusion: In our study, tattooing the bladder urothelium was successful. Despite the side effects of the used materials, tattooing remains feasible; however, the type of material, dose titration, and long follow-up are needed to detect the most suitable material.

Tarek Abdallah Swellam, Ahmed S Zayed, Muhammed Ali, Ahmed Refaat, Muhammed Magdy El-Mahdi, Muhammed M Wishahy

Submitted January 23, 2012 - Accepted for Publication March 12, 2013

KEYWORDS: Bladder tattooing, urothelial marking, Indian ink, ferrous sulphate

CORRESPONDENCE: Tarek Abdallah Swellam, MD, PhD, Theodor Bilharz Research Institute, Giza, Imbaba, Egypt ()

CITATION: UroToday Int J. 2013 April;6(2):art 26.


Chordee without Hypospadias with a Communicating Symptomatic Epidermoid Cyst: An Unusual Presentation


We present an unusual case of chordee without hypospadias with a communicating, symptomatic epidermoid cyst. A 12-year-old boy presented with painful erections, especially early in the morning, over the last year and a watery discharge from swelling located near the meatus for 2 months. On examination, ventral chordee was present, the meatus was orthotopic, the prepuce was normal, and a ~0.5X0.5 cm swelling was present near the meatus on the ventral aspect with watery discharge. During operation, it was found that this swelling had communication with the urethra, and it was an epidermoid cyst on histopathologic examination.

Avinash Dutt Sharma, Malay Kumar Bera, Anup Kumar Kundu

Submitted January 30, 2012 - Accepted for Publication February 21, 2013

KEYWORDS: Chordee, hypospadias, congenital, preputial

CORRESPONDENCE: Avinash Dutt Sharma, M.S., Institute of Postgraduate Medical Education & Research, Kolkata, West Bengal, India ()

CITATION: UroToday Int J. 2013 April;6(2):art 24.


Ileovesical Fistulae: A Rare Complication of Crohn Disease


An ileovesical fistula is a rare complication of Crohn disease. It presents with recurrent abdominal pain, pneumaturia, fecaluria, recurrent urinary tract infection, and dysuria. A 13-year-old girl presented with an ileovesical fistula, which was diagnosed by clinical history, micturating cystourethrogram, and computed tomography (CT) cystography. Exploratory laparotomy, an excision of the fistulous tract, bladder repair, and ileostomy were performed. The histopathological examination of a resected, affected ileal segment showed the classical non-caseating granuloma, characteristic of Crohn disease. The restoration of bowel continuity was done later on. The patient is doing well after 3 years of follow-up.

Vishwajeet Singh, Dheeraj Kumar Gupta, Rahul Janak Sinha, Seema Mehrotra

Submitted February 2, 2012 - Accepted for Publication February 21, 2013

KEYWORDS: Ileovesical fistulae, pneumaturia, Crohn disease

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

CITATION: UroToday Int J. 2013 April;6(2):art 23.


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