Diagnostic and prognostic role of computed tomography in extracorporeal shock wave lithotripsy complications

Abstract

Purpose:To evaluate the role of multidetector computed tomography (MDCT) in recognizing the complications of extracorporeal shock wave lithotripsy (ESWL) and providing a prognostic grading system for the therapeutic approach.Materials and Methods:A total of 43 patients who underwent ESWL because of urinary stone disease were assessed by 320-row MDCT examination before and after ESWL. Pre-ESWL CT unenhanced scans were performed for diagnosing stone disease. Post-ESWL CT scans were acquired before and after intravenous injection of contrast medium searching for peri-renal fluid collection or hyper-density, pyelic or ureteral wall thickening, blood clots in the urinary tract, peri- or intra-renal hematoma or abscess, active bleeding. A severity grading system of ESWL complications was established.Results:Patients were affected by renal (n = 36) or ureteral (n = 7) lithiasis. Post-ESWL CT examination detected small fluid collections and hyper-density of peri-renal fat tissue in 35/43 patients (81%), pyelic or ureteral wall thickening in 2/43 (4%), blood clots in the urinary tract in 9/43 (21%), renal abscesses or hematomas with a diameter of <2 cm in 10/43 (23%), large retroperitoneal collections in 3/43 (7%), active bleeding from renal vessels in 1/43 (2%). Mild complications were found in 30 cases; moderate in 9; severe in 4. The therapeutic choice was represented by clinical follow-up (n = 20), clinical and CT follow-up (n = 10), ureteral stenting (n = 9), drainage of large retroperitoneal collections (n = 3), and arterial embolization (n = 1).Conclusion:MDCT plays a crucial role in the diagnosis of urolithiasis and follow-up of patients treated with ESWL recognizing its complications and providing therapeutic and prognostic indications.

Does Transient Cessation of Antiplatelet Medication Prior to Shock Wave Lithotripsy Have Any Safety Concern: Evaluation of the Short Term Safety Results

“…Related with this subject, experimental as well as clinical findings reported in the literature suggest that treatment with SWL may cause renal parenchymal damage resulting in some minor as well as major adverse effects like hematoma formation [1,8,15]. Evident damage to blood vessels in the path of the shock waves has been well documented in the majority of these studies and it has been suggested that the primary injury occurs in renal vascular tissue.…”

“…Evident damage to blood vessels in the path of the shock waves has been well documented in the majority of these studies and it has been suggested that the primary injury occurs in renal vascular tissue. Documented vascular injury has been characterized with the areas of intraparenchymal hemorrhage and edema the extent of which sometimes may include both medulla as well as the cortex where it forms a subcapsular hematoma [8]. Although the most common clinical manifestation of renal vascular trauma is spontaneously resolving macroscopic hematuria, symptomatic intrarenal, subcapsular or perirenal fluid collections and hematomas may also form rarely in about <1% of patients undergoing SWL.…”

“…Depending on the method used for radiologic evaluation, the presence of perirenal or intrarenal hematoma formation was reported to be between 0.1 and 0.6% on ultrasonographic evaluation and between 20 and 25% on MRI or CT evaluations [5,6,7,8]. Lastly, studies again demonstrate that while almost all cases undergoing SWL experience hematuria and as many as 25% may demonstrate an asymptomatic hemodynamically insignificant subcapsular hematoma, large-sized retroperitoneal hematomas requiring blood transfusions may also form rarely in a limited percentage of patients [9,10].…”