Neurologic complications in percutaneous nephrolithotomy.

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.

Supine percutaneous nephrolithotomy: con.

Advocates of supine percutaneous nephrolithotomy (PCNL) consider several theoretical advantages for this procedure. Despite the potential advantages of the supine PCNL, the majority of urologists have remained reluctant to perform this technique. This reluctance may be related to successful outcomes of prone PCNL and technical difficulties associated with supine PCNL. Feasibility of supine PCNL has been shown in different series and the current evidence, although limited and not fully organized, implies the application of this technique for patients with simple stones who are at high anesthesiological risk. However, there is no convincing evidence to support performing supine PCNL in morbidly obese patients and those with complex and multiple stones. Further randomized clinical trials of large sample size and high methodological quality are required to recommend extensive application of supine PCNL as an alternative to prone PCNL.

Expression of survivin and its spliced variants in bladder tumors as a potential prognostic marker.

INTRODUCTION: Survivin, a novel inhibitor of apoptosis, is re-expressed in a vast majority of human cancers and is widely considered as a diagnostic marker of cancers. Survivin protein regulates both cell division and apoptosis. There are at least 5 spliced variants of the gene with different subcellular localization and anti-apoptotic property. We examined the expression pattern of survivin and its 2 spliced variants, survivin-deltaEx3 and survivin-2B, and their prognostic values in archival collections of formalin-fixed paraffin-embedded samples of bladder tumors. MATERIALS AND METHODS: Total RNA from formalin-fixed paraffin-embedded samples (51 samples from 30 patients with bladder cancer and 5-year follow-up) were extracted and analyzed by semiquantitative reverse transcriptase polymerase chain reaction technique. Tissue distribution and subcellular localization of survivin protein in tumor tissues was also examined by immunohistochemistry. RESULTS: The expression of survivin, survivin-deltaEx3, and survivin-2B were detected in 66.6%, 47.8%, and 54.7% of the specimens, respectively. The expression of survivin and survivin-deltaEx3 were preferentially elevated in tumors with higher grades, whereas survivin-2B expression was lower in high-grade tumors (P = .04). A reverse correlation was observed between survivin-2B expression and high-grade tumors. Immunohistochemistry results also confirmed the nuclear localization of survivin protein within tumoral cells. CONCLUSION: We were successful in detecting the expression of survivin and its variants in formalin-fixed paraffin-embedded bladder samples. Furthermore, our results showed that overexpression of survivin and survivin-deltaEx3 in bladder tumors correlates with poor prognosis of bladder cancer. We suggest that survivin and its variants are suitable prognostic markers of bladder tumors.

The frequency of prostatic involvement in radical cystectomy specimens for transitional cell carcinoma of the bladder.

OBJECTIVE: To evaluate the frequency of prostatic involvement in pathologic samples of the patients who had undergone radical cystectomy due to transitional cell carcinoma (TCC) of the bladder. MATERIALS: The files of the patients who had been subjected to radical cystectomy due to bladder TCC between 1998 and 2004 were evaluated retrospectively. A total of 164 radical cystectomies had been done during this period. Seventeen cases were excluded because the primary tumour was not TCC or the patient had previously undergone prostatectomy. RESULTS: Of 147 patients, 36 (24/4%) had prostate TCC and 19 (12.9%) had prostate adenocarcinoma. Two patients had both TCC and prostate adenocarcinoma. Twenty-one cases had superficial bladder cancer (T1) and prostatic involvement was detected in TCC cases but in 9.5% of those with adenocarcinoma. The prevalence of prostate adenocarcinoma in radical cystectomy samples (due to bladder TCC) is much lower in Iranian patients in comparison with the European and American patients (vs 12.9 and 17.5 to 45%, respectively). CONCLUSION: Prostatic involvement by TCC had a direct relation with the stage (P = .01) and grade (P = .008) of the bladder tumour. If we try to preserve the prostate or its capsule during the radical cystectomy procedure, attention to these findings is worthwhile