Air embolism during percutaneous nephrolithotomy using air pyelogram during initial access: Does it really occur?

Anshul Garg, Mohd Mubashir Ali Khan, Praveen Singh, Manish Kumar Agarwal, Anshul Garg, Mohd Mubashir Ali Khan, Praveen Singh, Manish Kumar Agarwal

Abstract

Introduction: In the present era, percutaneous nephrolithotomy (PCNL) is the standard treatment for large (>2 cm) renal or staghorn renal stones. Both air and iodinated contrast has been used to opacify the pelvicalyceal system (PCS) before the dilatation of the tract. There are rare reports of air embolism following air pyelogram on mere presumptions.

Materials and methods: This is a prospective observational study. A total of 164 patients underwent PCNL in which air was used to opacify the PCS by placing a ureteric catheter for initial access.

Results: None of our patients developed any complication during the procedure or in the postoperative period, which could be attributed to air embolism.

Conclusions: The present study ascertains that using air for opacification of PCS for initial puncture access is a safe and acceptable alternative to iodinated contrast.

Keywords: Air embolism; air pyelogram; percutaneous nephrolithotomy.

Conflict of interest statement

There are no conflicts of interest.

Copyright: © 2019 Urology Annals.

Figures

Figure 1
Figure 1
Retrograde air pyelogram using the ureteric catheter
Figure 2
Figure 2
Initial access utilizing retrograde air pyelogram

References

    1. Fernström I, Johansson B. Percutaneous pyelolithotomy. A new extraction technique. Scand J Urol Nephrol. 1976;10:257–9.
    1. Ramakumar S, Segura JW. Renal calculi. Percutaneous management. Urol Clin North Am. 2000;27:617–22.
    1. Basiri A, Ziaee AM, Kianian HR, Mehrabi S, Karami H, Moghaddam SM. Ultrasonographic versus fluoroscopic access for percutaneous nephrolithotomy: A randomized clinical trial. J Endourol. 2008;22:281–4.
    1. Jangid DK, Sharma G, Yadav SS, Tomar V, Mathur R. A comparative study of antegrade air pyelogram and retrograde air pyelogram for initial puncture access during percutaneous nephrolithotomy. J Clin Diagn Res. 2017;11:PC01–3.
    1. Lipkin ME, Mancini JG, Zilberman DE, Raymundo ME, Yong D, Ferrandino MN, et al. Reduced radiation exposure with the use of an air retrograde pyelogram during fluoroscopic access for percutaneous nephrolithotomy. J Endourol. 2011;25:563–7.
    1. Varkarakis J, Su LM, Hsu TH. Air embolism from pneumopyelography. J Urol. 2003;169:267.
    1. Song SH, Hong B, Park HK, Park T. Paradoxical air embolism during percutaneous nephrolithotomy: A case report. J Korean Med Sci. 2007;22:1071–3.
    1. Basiri A, Soltani MH, Kamranmanesh M, Tabibi A, Mohsen Ziaee SA, Nouralizadeh A, et al. Neurologic complications in percutaneous nephrolithotomy. Korean J Urol. 2013;54:172–6.
    1. Parikh GP, Sonde SR, Kadam P. Venous air embolism: A complication during percutaneous nephrolithotomy. Indian J Urol. 2014;30:348–9.
    1. Ko R, Soucy F, Denstedt JD, Razvi H. Percutaneous nephrolithotomy made easier: A practical guide, tips and tricks. BJU Int. 2008;101:535–9.

Source: PubMed

Sponsors et collaborateurs

Les conditions médicales

Interventions en matière de drogue

3
S'abonner