Complications Of Percutaneous Nephrolithotomy Research Articles

The Association of Stone Opacity in Plain Radiography with Percutaneous Nephrolithotomy Outcomes and Complications.

To investigate the influence of stone opacity in plain radiography on stone free rate and complications ofpercutaneous nephrolithotomy (PCNL). A number of 101 patients who underwent PCNL between July-September 2015 wereprospectively included. Stone opacity was judged on preoperative plain Kidney-Ureter-Bladder X-ray. Stone freerate was evaluated two weeks after the operation by ultrasonography and KUB. There were 61 patients with opaque stones and 40 patients with non-opaque stones. The age, body massindex, preoperative creatinine, history of stone surgery, and stone size was not statistically different betweenpatients with opaque and non-opaque stones. Neither operation duration nor access numbers were statisticallysignificant between opaque and non-opaque stones. The frequency of stone free patients in opaque stones and nonopaquestones were 55/61 (90%) and 30/40 (75%) respectively (P = .04) The magnitude of hemoglobin drop inopaque stones and non-opaque stones were 1.9 ± 1.2 mg/dL versus 2.9 ± 1.7 mg/dL (P = .005). The stone free rate is lower and the magnitude of bleeding is higher in PCNL of non-opaque stoneswhen compared to opaque stones if rigid instruments are used for nephroscopy.

Complications of Percutaneous Nephrolithotomy and their Management

Introduction: Increasing global prevalence of nephrolithiasis has resulted in the development of new minimally invasive techniques and has also led to the resurgence of established methods such as percutaneous nephrolithotomy (PCNL). This procedure is now recommended as the first option for the treatment of single large or multiple renal stones and those in the inferior calyx. This study was done to assess the complications of PCNL and their management, in our centre.
 
 Methods: Medical records of 144 patients who underwent PCNL at Lumbini Medical College Teaching Hospital, during the last one year were reviewed. The demographic data, size, tract number and location of the calculi, and intraoperative and postoperative complications were evaluated. The various parameters of the calculi were evaluated. Descriptive analysis with frequencies was done.
 
 Results: Complications occurred in 13 (9.02%) patients. Post operative bleeding occurred in seven (4.8%) patients, out of which one patient developed pseudoaneurysms and the other developed arteriovenous fistula. One patient developed hypovolemic shock immediately after surgery. Frequent blockage of urine, excessive drainage of urine from the drain site, hemothorax and colonic perforation was seen in one patient each. One patient had mortality due to post operative bleeding. Complications increased with the number and size of stones and number and site of the tracts.
 
 Conclusion: Percutaneous nephrolithotomy has low complication rate in experienced hands and complications depend upon stone size, history of open stone surgery, tract number, and tract location.

Ovarian vein thrombosis: A complication of percutaneous nephrolithotomy.

The medical and surgical complications of percutaneous nephrolithotomy (PCNL) are well-known, including deep venous thrombosis. Ovarian vein thrombosis (OVT) is a rare, but potentially serious type of venous thrombosis that has not previously been reported as a complication of PCNL or ureteral stent placement. We report a case of OVT associated with ureteral stenting following a tubeless PCNL. This complication was successfully managed conservatively without any short- or long-term sequelae.

BODY MASS INDEX RELATIONS WITH THE DIFFICULTIES AND COMPLICATIONS OF PERCUTANEOUS NEPHROLITHOTOMY

Objective: To identified outcomes and complications of percutaneous nephrolithotomy (PCNL) in patients of various body mass indices (BMI) to determine the safety of this procedure in patients with elevated BMI.Material & methods: The analytic observational prospective study of patients who underwent PCNL between February to July 2015 in the operating room Soetomo General Hospital Surabaya. Specifically, BMI, stone-free rates, difficulties duringsurgery, complications, and Clavien score were assessed. We evaluate the independent contribution of BMI as a predictor of outcomes. Results: There were 35 selected patients with kidney stone and planned to PCNL, 20 patients were included and 15 patients were excluded from this study. The patients consisted of 10 men (50%) and 10 women (50%). Mean age was 47.55 years (range 33-75). There were 4 patients with diabetes (20%), and 10 patients with hypertension (50%). Mean stone size was 23.30 mm. Stone location was 11 patients (55%) in the right kidney, and 9 patients (45%) in the left. There were 12 patients (60%) with a single stone, and 8 patients (40%) with multiple stones. BMI values were distributed as follows,underweight 1 patient (5%), normoweight 7 patients (35%), overweight 6 patients (30%), obesity 6 patients (30%). Mean skin to stone distance (SSD) was 87.56 mm. Stone free rate was 55%, and difficulties during surgery only seen in 1 patient (5%) bleeding profusely and open surgery was performed. Clavien score in these patients were grade I in 11 patients (55%), grade II in 7 patients (35%), and grade IIIB in 2 patients (10%). The BMI had no significant effect with Intra operative and postoperative difficulties (0.390. p <0.05. CI 95%). However the lower stone free rate had significant effect (0.040. p <0.05. CI 95%).Conclusion: BMI had no significant effect with Intraoperative and postoperative difficulties in PCNL.However, the lower stone-free rate risk associated with elevated BMI was significant.

Chylothorax as a Complication of Percutaneous Nephrolithotomy

Percutaneous nephrolithotomy is a minimally invasive procedure to remove large renal calculi. Complications can range from infection to bowel damage but only rarely does the procedure result in pulmonary injury. We present the first case of chylothorax secondary to percutaneous nephrolithotomy for removal of a large renal calculus. The patient was treated with a decortication procedure and discharged to rehab shortly thereafter.

Evaluate the Severity of Complications for Percutaneous Nephrolithotomy and Open Surgery for Large Renal Stone

Urinary stone disease is the third most common problem in urology clinics after urinary tract infections and prostate disease. Objectives: evaluate severity of complications of percutaneous nephrolithotomy (PNL) and open surgery for large renal stones. Patients: 150 adult patients with renal stones more than 2 cm were distributed into two equal groups. Group A had PNL and group B had open surgery. Design: Quasi- experimental research design. Setting Assiut Urology and Nephrology Hospital. Tools: (1) Patient assessment sheet and (2) Clavien-Dindo grading system for classification of surgical complications. Results: No significant relation between the both group regarding complications, stone clearance and need for blood transfusion, while mean hospital stays showed significant relation between the both group. As a group (A) stay only 3.7±1.2 days in hospital after operation while group B stay longer time, 6.1±0.53 days after operation.Conclusions: Open renal surgery for large sized stones still has its role in selected cases with stone clearance and complications rates comparable to PNL. Recommendation: The choice between PNL and open surgery for renal stones should be individualized for each patient.

To stratify complications of percutaneousnephrolithotomy (PCNL) in a single hospital by use of the modified Clavien grading system

Introduction: PCNL is relatively safe but evaluating its complication can be of importance so that we can betteranticipate and act on it.Purpose: To evaluate the complications of percutaneous nephrolithotomy (PCNL).Materials and methods: We prospectively analyzed the patients who underwent conventional PCNL at KMCTH from March 2013 to July 2015. Eighty five cases with renal stones more than 1cm and upper ureteric stones were included in the study. Patients with coagulation disorder were not included in this study. Ten patients who had PCNL converted to open procedures were excluded in the study. Patients underwent PCNL in prone position. Pre-operative complete blood count, urine, ultrasound(USG), intravenous Urography (IVU) was done. CT IVU was also done in few cases. During the period of which Demographic data, stone free rate, hospital stay and complications were assessed.Results: A total of 95 cases were enrolled for the study. Ten cases were excluded. There were 47 (55.29%) were female and 38 (44.71%) were male.Most of the patients had unilateral kidney stones(78.82%).Mean size of the was 1.85cm.There were 38(44.70%) renal pelvi-ureteric junction(PUJ) stones out of 85 cases. Sub-costal approach for PCNL was carried out in 78 (91.77%) patients. Mean operative time was 59.29 minutes with blood loss of 72.58 ml and three patients needed blood transfusion. Twelve patients (14.11%) experienced PCNL related complication. There was 1 mortality. Stone free rate was 91.76% (n-78).Conclusion: PCNL is safe with acceptable complication rate and has an acceptable high stone free rate.

Blood loss predictive factors and transfusion practice during percutaneous nephrolithotomy of kidney stones: a prospective study.

Objectives Bleeding is the most common complication of percutaneous nephrolithotomy (PCNL). Injudicious transfusion is frequently performed in current practice, even though it is not always needed. This study aimed to identify the predictive factors of blood loss in the PCNL procedure and evaluate the perioperative transfusion practice. Methods A prospective study of PCNL was randomly performed by two consultants of endo-urology at our institution. The inclusion criteria were adults with kidney pelvic stones >20 mm or stone in inferior calyx >10 mm or staghorn stone. Those with coagulopathy, under anti-coagulant treatment or open conversion were excluded. A full blood count was taken at baseline and during 12, 24, 36, 72-hours post-operatively. Factors such as stone burden, sex, body surface area, shifting of hematocrit level and amount of blood transfused were analyzed statistically using line regression to identify the predictive factors of total blood loss (TBL). Results Eighty-five patients were enrolled in this study. Mean TBL was 560.92 ± 428.43 mL for both endo-urology surgeons. Stone burden was the most influential factor for TBL (p=0.037). Our results revealed that TBL (mL) = -153.379 + 0.229 × stone burden (mm2) + 0.203 x baseline serum hematocrit (%); thus considerably predicted the need for blood transfusion. A total of 87.1% patients did not receive perioperative transfusion, 3.5% received intra-operative transfusion, 7.1% received post-operative transfusion, 23% had both intra and post-operative transfusion, resulting in a cross-matched transfusion ratio of 7.72. Mean perioperative blood transfused was 356.00 ± 145.88 mL.

Duodenal perforation during percutaneous nephrolithotomy (PCNL) in a pediatric patient: A case report

IntroductionColonic perforations are known complications of percutaneous nephrolithotomy (PCNL). However, to the best of our knowledge, small bowel perforation has rarely been reported.. ObservationWe report the case of a 7-year-old girl who presented with a duodenal perforation in the early postoperative period after undergoing PCNL for a calculus sized 2.5cm in the right renal pelvis. She was successfully managed conservatively. The diagnostic workup and management are discussed.

Outcome and complications of percutaneous nephrolithotomy as primary versus secondary procedure for renal calculi

ABSTRACTPurposeTo compare the efficacy of percutaneous nephrolithotomy (PCNL) as a primary procedure of patients following previous open surgery or post percutaneous nephrolithotomy (PCNL) for renal calculi.Materials and MethodsThe medical records of 367 patients who underwent PCNL by a single surgeon from January 2008 to December 2013 were reviewed retrospectively. All patients were divided into 3 Groups. Group-1 (n=232) included patients with no history of ipsilateral open stone surgery. Group 2 (n=86) patients had undergone one or more open stone surgeries before PCNL, patients with failed or recurrence following PCNL were placed in Group-3 (n=49). The demographic data, operation duration, stone free rate (SFR), number of attempts to access the collecting system and intra operative and postoperative complications between the three Groups were compared.ResultsThere was no difference in sex, Body Mass Index (BMI), stone burden and laterality among the three Groups. Operation time was significantly less in first Group, while there was a statistically significant difference in operation duration between second and third Groups (p<0.05). The number of attempts to enter the collecting system was lower in the first Group in comparison to other two Groups (p<0.5). There was no significant differences among three groups in stone free rate. Intra operative and postoperative complications were slightly more frequent in Groups 2 and 3. Mortality occurred in 1 patient with colon perforation in Group-2.ConclusionOur study demonstrated that PCNL can be performed in patients even as secondary procedure without further complications.

PD23-01 THE EFFECT OF CONTINUED ASPIRIN THERAPY IN PATIENTS UNDERGOING PCNL

You have accessJournal of UrologyStone Disease: Surgical Therapy IV1 Apr 2016PD23-01 THE EFFECT OF CONTINUED ASPIRIN THERAPY IN PATIENTS UNDERGOING PCNL Brandon Otto, Forat Lutfi, Russell Terry, Mohit Gupta, and VincentG Bird Brandon OttoBrandon Otto More articles by this author , Forat LutfiForat Lutfi More articles by this author , Russell TerryRussell Terry More articles by this author , Mohit GuptaMohit Gupta More articles by this author , and VincentG BirdVincentG Bird More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.1740AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Aspirin (ASA) is usually stopped prior to percutaneous nephrolithotomy (PCNL) over the concern for increased surgical bleeding. There is evidence that discontinuing ASA perioperatively increases thromboembolic events. Since 2012 we have continued ASA in all patients undergoing PCNL. We sought to review our experience to date. METHODS We retrospectively reviewed 285 consecutive PCNLs between 2012-2015 at our institution. We compared outcomes and complications of PCNL in patients continuing ASA to patients not taking ASA. Statistical analysis was performed with students t-test and chi-squared test. RESULTS 77 (27%) patients were maintained on ASA and 208 (73%) were not on ASA. Table 1 summarizes ASA dose and indications. The ASA group was older (66 vs 51 years, p<0.001), had more tobacco users (55.8% vs 31.7%, p<0.001) and a higher American Society of Anesthesiologist score (2.9 vs 2.5, p<0.001). There were no differences in mean stone size or blood loss between the ASA and non-ASA groups (37 vs 40 mm, p=0.127 and 42 vs 54 mL, p=0.05 respectively). There were no differences in residual stone fragment size following PCNL between the ASA and non-ASA groups (0-2 mm: 66.7% vs 61.9%, 3-4 mm: 19% vs 16%, >4 mm: 14.3% vs 22.4%, p=0.265 respectively). Length of stay and change in hemoglobin, hematocrit and creatinine were similar between the groups. (Table 2) There were no differences in the number of readmissions or total complications between the ASA and non-ASA groups (12.4% vs 12.4%, p=0.949, 31.6% vs. 26.7%, p=0.401 respectively). Additionally, there were no differences in the number of major complications, bleeding complications and transfusion rates between the ASA and non-ASA groups (8.9% vs 5.7%, p=0.366; 3.8% vs 3.3%, p=0.853; and 1.3% vs 1%, p=1.00 respectively). CONCLUSIONS PCNL appears both effective and safe in patients continuing ASA perioperatively. Postoperative hemorrhage was uncommon and this concern should not dissuade urologists from offering PCNL with perioperative ASA use to this patient population. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e505-e506 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Brandon Otto More articles by this author Forat Lutfi More articles by this author Russell Terry More articles by this author Mohit Gupta More articles by this author VincentG Bird More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

MP26-11 IS PRE-OPERATIVE URINE CULTURE SUFFICIENT TO PREDICT SEPTIC COMPLICATIONS OF PERCUTANEOUS NEPHROLITHOTOMY?

You have accessJournal of UrologyInfections/Inflammation/Cystic Disease of the Genitourinary Tract: Kidney & Bladder II1 Apr 2016MP26-11 IS PRE-OPERATIVE URINE CULTURE SUFFICIENT TO PREDICT SEPTIC COMPLICATIONS OF PERCUTANEOUS NEPHROLITHOTOMY? Marouene Chakroun, Walid Kerkeni, Abderrazak Bouzouita, Haroun Ayed, Mohamed Cherif, Amine Derouiche, Mohamed Riadh Ben Slama, and Mohamed Chebil Marouene ChakrounMarouene Chakroun More articles by this author , Walid KerkeniWalid Kerkeni More articles by this author , Abderrazak BouzouitaAbderrazak Bouzouita More articles by this author , Haroun AyedHaroun Ayed More articles by this author , Mohamed CherifMohamed Cherif More articles by this author , Amine DerouicheAmine Derouiche More articles by this author , Mohamed Riadh Ben SlamaMohamed Riadh Ben Slama More articles by this author , and Mohamed ChebilMohamed Chebil More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.2948AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Preoperative urine culture is essential before urologic surgery; its positivity may be associated with a high risk of postoperative complications. Our objective was to evaluate the incidence and the severity of septic complications after percutaneous nephrolithotomy (PNL), and determinate whether preoperative urine culture was predictive of these complications. METHODS We retrospectively analyzed data of 277 patients who had undergone PNL between 2009 and 2014. Septic complications occurred after surgical procedure were reported and then classified according to severity using the Clavien-Dindo classification. Univariate analysis was used to assess the impact pre-operative urine culture on the occurrence of septic complications. RESULTS The median age was 46 years (9 – 80). %). The median size of the stone was 30.69 mm (10-70). The average operative time was 167.38 mn (75-300). Complications occurred in 139 patients (55.37%), septic ones in 69 patients (24.9%), including 6 cases of retroperitoneal phlegmon (2.16%), one case of renal abscess (0.36%), 3 cases of pyelonephritis (1.08%), and 4 cases of prostatitis (1.44%). Fever with no etiology has been reported in 56 cases, it was considered as a septic complication. According to severity, grade 4 complications have been reported in 3 patients (1.08%), with recovery after resuscitation. Preoperative urine culture was positive in 17 patients (6.13%); all had peri-operative antibiotherapy adapted to the antibiogram. Seven of these patients (41.17%) had septic complications. In univariate analysis, preoperative urine culture was not predictive of septic complications (OR=1.27; p = 0.242). CONCLUSIONS Pre-operative urine culture was not sufficient to predict septic complications after PNL. Most patients who presented with septic complications post-operatively had negative preoperative urine culture. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e358 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Marouene Chakroun More articles by this author Walid Kerkeni More articles by this author Abderrazak Bouzouita More articles by this author Haroun Ayed More articles by this author Mohamed Cherif More articles by this author Amine Derouiche More articles by this author Mohamed Riadh Ben Slama More articles by this author Mohamed Chebil More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

An unusual cause of Grade IIIb Clavien complication of percutaneous nephrolithotomy: Broken and retained Malecot nephrostomy catheter

Percutaneous nephrolithotomy (PCNL) is a relatively safe operation with low rates of major complications. Clavien-Dindo classification is a validated system to record complications, although still needing standardization in reporting and scoring of complex and rare events. We report an unusual adverse incident that required interventional management and impacted the postoperative course. The case of a broken re-entry Malecot nephrostomy catheter as it was being removed on the third postoperative day of an otherwise uneventful PCNL is described. The retained part was removed by open-surgery under general anesthesia. This incident has upgraded the minimally invasive surgery to a Grade IIIb complicated procedure according to the modified Clavien classification. Patient data, procedure conditions, and surgical retrieval of the catheter are detailed. Although far from being life-threatening, this rare complication due to a broken and retained drainage catheter is regarded as a high-grade complication according to the Clavien system.

150 Is pre-operative urine culture sufficient to predict septic complications of percutaneous nephrolithotomy?

150 Is pre-operative urine culture sufficient to predict septic complications of percutaneous nephrolithotomy?

Complications of percutaneous nephrolithotomy: classification, management, and prevention.

Percutaneous nephrolithotomy (PCNL) provides the highest stone-free rate after one session and low morbidity rates in cases of large or multiple renal calculi. The classification, management, and prevention of complications of PCNL are reviewed. PCNL is a well tolerated and very effective procedure for the management of renal stones. Specific complications limit the surgical outcome of PCNL whereas the majority of the complications are resolving with conservative or minimally invasive management. Experience with the technique is important for minimizing complications. There is an ongoing effort to classify the complications and to achieve a consensus in reporting the complications and surgical outcome of the procedure. The knowledge of risk factors, complications, and their management is important for every endourologist. Establishing of a PCNL-specific classification system for reporting outcomes and complications could set the basis for further improvement of the PCNL technique and outcomes.

Retroperitoneal Urinoma after Percutaneous Nephrolithotomy

Percutaneous nephrolithotomy is the standart treatment for large,multiple renal Stones. Although this surgical technique was defined in 1979, the overall complication rate is approximetely 83%. The complications are divided into 2 groups; major and minor. Pain, fever, urinary tract infection and renal colic are minor complications. Septicemia and severe hemorrhage requiring blood transfusion are the most common major complications. Urinoma is one of the uncommon complication of percutaneous nephrolithotomy with an incidence of 0.1%. We report a case of retroperitoneal urinoma after percutan renal surgery.

Predictors of systemic inflammatory response syndrome following percutaneous nephrolithotomy.

Introduction and Objectives:Sepsis remains one of the dreaded complications of percutaneous nephrolithotomy (PCNL). To analyze prospectively the preoperative and intraoperative factors that predict the occurrence of systemic inflammatory response syndrome (SIRS) in patients undergoing PCNL so that we can aggressively manage those patients from the preoperative period itself and avert the dangerous complications.Materials and Methods:A prospective study was carried out between August 2012 and March 2013 including all patients who underwent PCNL. Patients with infected collecting system, synchronous ureteric stones, stents, or percutaneous nephrostomy drainage were excluded from the study. Patients were evaluated with physical examination, urine analysis, urine culture and sensitivity, complete blood count, renal function test, X-ray kidney, ureter, and bladder (KUB), and plain and contrast-enhanced computerized tomography KUB. Patients who developed any two or above of the following in the postoperative period were considered to have developed SIRS. (1) Temperature >100.4°F (38°C) or <96.8°F (36°C). (2) Pulse rate >90/min. (3) Respiratory rate >20/min. (4) White blood cell count >12,000/ml or <4000/ml.Results:Of the 120 patients who underwent PCNL 29 (24.1%) developed features of SIRS. On univariate analysis, gender, diabetes mellitus, bladder urine culture, and serum creatinine were found to be statistically insignificant. Blood transfusion (P = 0.009), no of access tracts (P = 0.001), pelvic urine culture (P = 0.04), stone culture (P = 0.003), stone size (P = 0.001), age (P = 0.019), and operative time (P = 0.004) were found to be statistically significant. On multivariate regression analysis stone size, no of access tracts, operative time, and stone culture were found to be statistically significant with regard to the occurrence of SIRS.Conclusion:Patients with above-identified risk factors must be aggressively treated to prevent the occurrence of sepsis postoperatively.

Factors Influencing Complications of Percutaneous Nephrolithotomy: A Single-Center Study.

Percutaneous nephrolithotomy (PNL) is a minimally invasive procedure used for successful treatment of renal calculi. However, it is associated with various complications. We assessed the complications and their potential influencing factors in patients who had undergone PNL. In total, 1750 patients who had undergone PNL from November 2003 to June 2011 were evaluated retrospectively. PNL complications and possible contributing risk factors (age, sex, serum creatinine level, previous operations, hydronephrosis, calculi size, localization, opacity, surgeon's experience, accessed calyxes, number of accesses, and costal entries) were determined. Receiver operating characteristic (ROC) analysis was used to investigate the cutoff values of the data. Ideal cutoff value was determined by Youden's J statistic. All the demographic and clinical variables were examined using backward stepwise logistical regression analysis. Continuous variables were categorized with logistic regression analysis according to the cutoff values. Complications occurred in 396 (24.4%) patients who had undergone PNL. Hemorrhage requiring blood transfusion occurred in 221 (12.6%) patients, hemorrhage requiring arterial embolization occurred in 7 (0.4%) patients, perirenal hematoma occurred in 17 (0.97%) patients, hemo-pneumothorax occurred in 32 (1.8%) patients, and colon perforation occurred in 4 (0.22%) patients. Three patients (0.06%) died of severe urosepsis, and one patient (0.02%) died of severe bleeding. The calculus size, localization, access site, number of accesses, presence of staghorn stones, surgeon's experience, and duration of the operation significantly affected the complication risk. Our retrospective evaluation of this large patient series reveals that, PNL is a very effective treatment modality for kidney stones. However, although rare, serious complications including death can occur.

11 Results and complications of percutaneous nephrolithotomy (PCNL): Report of over 12,000 cases in Southern Iran

11 Results and complications of percutaneous nephrolithotomy (PCNL): Report of over 12,000 cases in Southern Iran

Paradoxical air embolism during percutaneous nephrolithotomy due to patent foramen ovale: Case report.

Paradoxical air embolism is a very rare complication associated with percutaneous nephrolithotomy (PCNL). Incidence may be higher if patients also suffer from a septal heart defect. We report the case of a 76-year old male who presented for PCNL treatment of a right kidney lower calyceal calculus. During the procedure, the patient developed signs and symptoms consistent with that of air embolism. Intraoperative echocardiography confirmed the diagnosis. Subsequent intraoperative and postoperative medical management was carried out and the patient was discharged after recovery three days later. This case highlights the importance of a rare but potentially fatal complication of PCNL.