title: Neurologic complications in percutaneous nephrolithotomy.
abstract: OBJECTIVE
  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.
  
  
  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.
authors.affiliation: Urology and Nephrology Research Center, Shahid Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
authors.forename: Abbas
authors.initials: A
authors.lastname: Basiri
authors.forename: Mohammad Hossein
authors.initials: MH
authors.lastname: Soltani
authors.forename: Mohammadreza
authors.initials: M
authors.lastname: Kamranmanesh
authors.forename: Ali
authors.initials: A
authors.lastname: Tabibi
authors.forename: Seyed Amir
authors.initials: SA
authors.lastname: Mohsen Ziaee
authors.forename: Akbar
authors.initials: A
authors.lastname: Nouralizadeh
authors.forename: Farzaneh
authors.initials: F
authors.lastname: Sharifiaghdas
authors.forename: Mahtab
authors.initials: M
authors.lastname: Poorzamani
authors.forename: Babak
authors.initials: B
authors.lastname: Gharaei
authors.forename: Ardalan
authors.initials: A
authors.lastname: Ozhand
authors.forename: Alireza
authors.initials: A
authors.lastname: Lashay
authors.forename: Ali
authors.initials: A
authors.lastname: Ahanian
authors.forename: Alireza
authors.initials: A
authors.lastname: Aminsharifi
authors.forename: Mehrdad Mohammadi
authors.initials: MM
authors.lastname: Sichani
authors.forename: Mohammad
authors.initials: M
authors.lastname: Asl-Zare
authors.forename: Faramarz Mohammad
authors.initials: FM
authors.lastname: Ali Beigi
authors.forename: Vahid
authors.initials: V
authors.lastname: Najjaran
authors.forename: Mehdi
authors.initials: M
authors.lastname: Abedinzadeh
authors.forename: Mohammad Masoud
authors.initials: MM
authors.lastname: Nikkar
keywords: Complications; Nephrolithotomy; Neurologic deficits; Paraplegia