Intraparenchymal hematoma as a late complication of retrograde intrarenal surgery

Abstract

A 34 year-old woman was admitted to our hospital with left flank pain. A non-contrast enhanced computerized tomography (NCCT) revealed a 1.5x2cm left proximal ureter stone. Patient was scheduled for ureterorenoscopy (URS) and stone removal. She was submitted to retrograde intrarenal surgery (RIRS). At the postoperative 1st day, the patient began to suffer from left flank pain. A NCCT was taken, which revealed a subcapsular hematoma and perirenal fluid. The patient was managed conservatively with intravenous fluid, antibiotic and non-steroidal anti-inflammatory drug therapy and was discharged at the postoperative 6th day. Two weeks after the discharge the patient was admitted to emergency department with severe left flank pain, palpitation and malaise. KUB (kidney-ureter-bladder) radiography showed double-J stent (DJS) to be repositioned to the proximal ureter. Patient was evaluated with contrast enhanced CT which revealed an 8cm intraparenchymal hematoma/abscess in the middle part of the kidney. A percutaneous drainage catheter was inserted into the collection. The percutaneous drainage catheter and the DJS were removed at the 10th day of second hospitalization. RIRS surgery is an effective and feasible choice for renal stones with high success and acceptable complication rates. However, clinician should be alert to possible complications.

A Novel Complication Following Retrograde Intrarenal Surgery: Retroperitoneal Hematoma

“…8 There are a few case reports in the literature on hematoma seen following RIRS, but those cases were treated by secondary manipulations. 9,10 Since hematoma transformed into abscess formation in the late period in these cases, open surgical intervention or percutaneous drainage was carried out. Also the hematoma was limited in the intraparenchymal or subcapsular region in those cases.…”

Possibilities of retrograde intrarenal surgery in the treatment of renal lower pole stones in children

“…Ureteral perforation, urinoma, bleeding, renal puncture with instruments or accessories, postoperative hydronephrosis, urinary tract infection, urosepsis, etc. are possible complications [16][17][18] . None of them was found in our series.…”

Complications of endourological procedures and their treatment

“…Complications rate is generally low and not severe. Major complications occur in fewer than 0.1% of cases and among these renal subcapsular hematoma (RSH) is exceedingly rare and reported in few papers in literature (7)(8)(9). We believe that, although rare, subcapsular hematoma of the kidney deserves attention from endourologists for its severity.…”