Extracorporeal Shock Wave Lithotripsy Induced Perirenal Hematomas

Knapp, Peter M.; Kulb, Thomas B.

doi:10.1016/s0022-5347(17)75305-0

Cited by 32 publications

(52 citation statements)

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“…[9][10][11] With the HM3 electrohydraulic lithotripter, the incidence of post-SWL symptomatic peri-renal hematomas detected by ultrasound is estimated to be 0.1% to 0.6%. [12][13][14] With the use of more sensitive abdominal computed tomography scanning, the rate of asymptomatic peri-renal hematomas is up to 25%. 15,16 Although a retrospective series of 5 (0.49%) patients with symptomatic peri-renal hematomas found that all 5 patients were hypertensive, 3 had diabetes mellitus, and 2 had coronary artery disease, these risk factors have not been consistently demonstrated with the exception of uncontrolled hypertension.…”

Section: Resultsmentioning

confidence: 99%

“…15,16 Although a retrospective series of 5 (0.49%) patients with symptomatic peri-renal hematomas found that all 5 patients were hypertensive, 3 had diabetes mellitus, and 2 had coronary artery disease, these risk factors have not been consistently demonstrated with the exception of uncontrolled hypertension. 13,17 Recently, an ultrasound examination of all patients post-SWL with the electromagnetic Storz Modulith SLX lithotripter (Storz, St. Louis, MO) found the incidence of asymptomatic peri-renal hematomas to be 4.1%, while the incidence of symptomatic peri-renal hematomas was similar to other lithotripters at a rate of 0.7%. 18 Furthermore, the probability of hematoma increased 1.67 times for every 10-year increase in patient age.…”

Section: Resultsmentioning

confidence: 99%

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Shock wave lithotripsy in patients requiring anticoagulation or

Alsaikhan

Andonian

2011

CUAJ

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Extracorporeal shockwave lithotripsy (SWL) remains the only truly minimally invasive procedure for the treatment of upper tract nephrolithiasis. Recently, there has been a recent rise in the patients on antiplatelet agents. Therefore, the aim of the present study is to review the literature available regarding SWL in these high-risk patients requiring anti-coagulation therapy. Alternative therapies to SWL are also presented. RésuméLa lithotripsie extracorporelle par ondes de choc (LECOC) demeure la seule intervention qui soit réellement minimalement invasive pour le traitement de la néphrolithiase dans les voies urinaires supéri-eures. Récemment, on a noté une hausse du nombre de patients traités par antiplaquettaires. Par conséquent, le but de la présente étude est d'examiner les articles publiés sur la LECOC chez ces patients à risque élevé ayant besoin d'un traitement anticoagulant. On présente également des traitements de rechange à la LECOC.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Shock wave lithotripsy in patients requiring anticoagulation or

Alsaikhan

Andonian

2011

CUAJ

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“…[14] Clinical and experimental studies have shown that this treatment might have severe, acute and chronic effects on the kidney and its peripheral tissues. [15][16][17] Acute renal changes after ESWL emerge as a significant decrease in effective renal plasma flow and GFR in the first 24 -48 h. [18] Possible chronic changes include an increase in blood pressure, decrease in renal function and increased recurrence of developing kidney stone. Renal damage in ESWL is known to be primarily avascular lesion.…”

Section: Discussionmentioning

confidence: 99%

Effects of Previous Unsuccessful Extracorporeal Shockwave Lithotripsy Treatment on the Performance and Outcome of Percutaneous Nephrolithotomy

Garg¹,

Mishra²,

Bharti³

et al. 2017

jemds

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BACKGROUNDMajority of renal stones diagnosed today are below 2 cm, perhaps due to easy and early accessibility to x-ray and ultrasonography. The preferred treatment of < 1 cm stone is extracorporeal shockwave lithotripsy (ESWL), while standard of care for renal stone > 2 cm is percutaneous nephrolithotomy (PCNL). The procedure of choice for 1 -2 cm renal stones is still a subject of debate. Controversy exists with regard to optimum management of these stones by percutaneous nephrolithotomy (PCNL) and extracorporeal shockwave lithotripsy (ESWL) with reference to stone clearance, hospital stay and complications. The primary goal while treating renal stones is to achieve complete clearance, while causing minimal morbidity to the patient. Treatment of renal stone depends on stone size and location plus patient related factors including anatomy of pelvicalyceal system. In our study, previous ESWL treatment had no influence on the PCNL stone-free rate, operation time, incidence of postoperative complications and LOS in patients with similar stone burdens. However, bleeding during PCNL was more prevalent in the ESWL-treated patients, so close attention should be paid to bleeding in patients who have been pretreated with ESWL.The objective of this study is to evaluate the effects of previous unsuccessful extracorporeal shockwave lithotripsy (ESWL) treatment on the performance and outcome of percutaneous nephrolithotomy (PCNL). MATERIALS AND METHODSOf 115 PCNL procedures performed in our institute with similar stone burden and number of accesses was included in the present study. We categorised the study patients into two groups according to whether they underwent ESWL within 1 year prior to PCNL or not. Accordingly, Group 1 comprised of 42 (36.5%) ESWL-treated patients and Group 2 comprised of 73 (63.4%) non-ESWLtreated patients. RESULTSThere were no statistically significant differences between the groups for length of hospital stay (LOS), nephrostomy tube removal time and the presence of residual stones. When we evaluated the groups for both the preoperative and postoperative haemoglobin (Hb) drop and blood transfusion rate, manifest Hb declined and more transfusions were required in the ESWL-treated patients (both P= 0.01). CONCLUSIONMany patients who undergo PCNL have undergone ESWL treatment beforehand. The renal side-effects of ESWL are well known, the duration of which varies between studies. In the present study, we found that previous ESWL had an effect on bleeding during the PCNL procedure.

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“…Most of the damage typically caused by shock-wave treatments is routinely observed and is not considered to represent severe pathological change, but the occurrence of perirenal hematoma has increased significantly in patients with pre-existing or poorly controllable hypertension [47]. Physiological tests have revealed only minor, transient reductions of renal plasma flow in the treated kidney [45,82] and no clinically relevant changes in blood chemistry [17].…”

Section: Side Effectsmentioning

confidence: 99%

“…Petechial bleeding of the skin that can be observed macroscopically has been found in about 10% of patients [29]. Varying degrees of subcapsular fluid collection and hemorrhage have been detected using different methods [4,37,71].Most of the damage typically caused by shock-wave treatments is routinely observed and is not considered to represent severe pathological change, but the occurrence of perirenal hematoma has increased significantly in patients with pre-existing or poorly controllable hypertension [47]. Physiological tests have revealed only minor, transient reductions of renal plasma flow in the treated kidney [45,82] and no clinically relevant changes in blood chemistry [17].…”

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confidence: 99%

Biological effects of shock waves

1990

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Summary.Extracorporeal shock wave lithotripsy has become established worldwide as the method of choice for the treatment of nephrolithiasis and ureterolithiasis over the last 10 years. Although initial studies showed no damaging effects of the shock waves on organs and tissues, numerous recent reports have presented evidence for severe acute effects and chronic complications after shock wave treatment. The pathophysiological effects on kidneys and the histopathological effects on organs or tissues in man and animal, and also the effects on ceils in culture and tumors are sumarized. Suspended and immobilized cell cultures were used to characterize and quantify the efficacy of shock wave. Extended applications of shock waves and possible modifications to shock wave generators are discussed.A reproducible generation of shock waves in fluids was first reported by Eisenmenger [31,32], who described an electromagnetic arrangement using a flat solenoid and a metal membrane. About 20 years later, underwater sparkgap-induced shock waves were used for kidney stone disintegration [17], a procedure that has become clinical routine [30]. In the meantime, the third generation of lithotripters has been developed (Siemens Lithostar Plus, Dornier Compact, Storz Modulith). Most of them are equipped with electromagnetic shock-wave emitters (EMSE), but piezo-electric shock-wave sources (Piezolith 2500, Diasonics) with similar properties for stone fragmentation are also in clinical use. However, all commercially available shock-wave generators (spark gap, electromagnetic, piezo-electric) produce side effects that accompany stone disintegration in patients. Furthermore, their biological effects are described as injuries to organs or tissues in vivo that have been exposed to the focal area of shock waves and as damage to cells in culture that have been treated with shock waves. * Dedicated to Prof. Dr. Wolfgang Eisenmenger on the occasion of his 60th birthday Side effectsIn kidney-or gallstone treatment with shock waves, side effects are equivocally classified and certainly depend not only on the number and energy of the applied shock waves but also on the disposition of the patients. Petechial bleeding of the skin that can be observed macroscopically has been found in about 10% of patients [29]. Varying degrees of subcapsular fluid collection and hemorrhage have been detected using different methods [4,37,71].Most of the damage typically caused by shock-wave treatments is routinely observed and is not considered to represent severe pathological change, but the occurrence of perirenal hematoma has increased significantly in patients with pre-existing or poorly controllable hypertension [47]. Physiological tests have revealed only minor, transient reductions of renal plasma flow in the treated kidney [45,82] and no clinically relevant changes in blood chemistry [17]. Furthermore, cytoplasmic enzymes have been reported to be only transiently released into the blood and urine of shock-wave-treated patients [46]. Kishimoto et al. [46] ha...

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Extracorporeal Shock Wave Lithotripsy Induced Perirenal Hematomas

Cited by 32 publications

References 0 publications

Shock wave lithotripsy in patients requiring anticoagulation or

Shock wave lithotripsy in patients requiring anticoagulation or

Effects of Previous Unsuccessful Extracorporeal Shockwave Lithotripsy Treatment on the Performance and Outcome of Percutaneous Nephrolithotomy

Biological effects of shock waves

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