INTRODUCTION AND OBJECTIVES: Renal hematoma after ureteroscopic lithotripsy(URSL) using Holmium:yttrium-aluminum-garnet(Ho:YAG) laser is a rare complication.
We aimed to review our center's experience of post-URSL subcapsular hematoma.
MATERIALS AND METHODS: From 2007 to 2012, 1114 URSLs using 7.5French(Fr) semi-rigid ureteroscopes were performed. Patients with post-URSL symptomatic renal hematoma were reviewed. Peri-operative information on patients' pre-operative morbidity, renal function, stone characteristics, and degree of hydronephrosis were reviewed. Operative information, post-operative presentation of symptoms, changes in blood parameters, CT findings, and subsequent management were documented.
RESULTS: Post-URSL subcapsular hematoma was diagnosed in 4 out of 1114 (0.36%) patients, who ranged in age from 43 to 63. Pre-operative imaging showed that all four patients had obstructing proximal ureteric stones ranging in size from 0.7 to 2.1 cm, and three of them had thin renal cortices. Pressure bags were not used, and double-J ureteric stents were inserted in all cases. All four patients had the triad of loin pain, fever, and significant hemoglobin drop requiring transfusion. Three patients presented within 2 days of URSL and one patient presented on day 20. One patient was managed conservatively and recovered with bed rest and antibiotics. An urgent angiogram was performed on one patient in view of a significant drop in hemoglobin, but no embolization was needed. One patient underwent ultrasound-guided drainage of the hematoma, and another had an emergency open clot evacuation due to significant compression on the kidney by the hematoma. Follow-up CT scans confirmed the resolution of the hematoma in all cases.
CONCLUSIONS: Post-URSL subcapsular hematoma is a rare but potentially serious complication. A high index of suspicion is needed when patients present with significant loin pain and fever after URSL for obstructing proximal ureteric stones with thin renal cortices. The management of post-URSL subcapsular hematomas needs to be customized for each patient.
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Written by:
Chiu PK, Chan CK, Ma WK, To KC, Cheung FK, Yiu MK. Are you the author?
Princess Margaret Hospital, Department of Surgery, Dept of Surgery, Princess Margaret Hospital, Hong Kong, Hong Kong, Hong Kong.
Reference: J Endourol. 2013 May 17. Epub ahead of print.
doi: 10.1089/end.2013.0128
PubMed Abstract
PMID: 23682955
UroToday.com Endourology Section