Renal Pseudoaneurysm after Flexible Ureterorenoscopy - An Unusual Complication

Durner, Leopold; Howairis, Mohamed El; Buchholz, Noor

doi:10.1159/000441042

Cited by 14 publications

(9 citation statements)

References 8 publications

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“…RAP is a pulsatile hematoma formed by blood outflow from the rupture of the renal artery wall and is wrapped by perirenal soft tissue ( 5 ). The wall of an RAP tumor is not a real blood vessel wall but a cystic wall formed by the organization of tissue around the hematoma.…”

Section: Discussionmentioning

confidence: 99%

“…If an inappropriate guide wire with hard or poor flexibility is chosen, the wire may damage the kidney. However, with the development of technology and materials, super-slippery guide wires have appeared, and the possibility of kidney damage caused by guide wires is lessened ( 5 ); however, they cannot be completely avoided. This may be related to the improper use of the guide wire during the operation or the pathological changes of the kidney itself.…”

Section: Discussionmentioning

confidence: 99%

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Renal Pseudoaneurysms after Flexible Ureteroscopy and Holmium Laser Lithotripsy: A Case Report

Deng

Zhang

et al. 2022

Front. Surg.

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BackgroundFlexible ureteroscopy (FURS) and holmium laser lithotripsy is considered one of the most minimally invasive and safe surgical methods for the treatment of renal calculi. Renal pseudoaneurysm is a rare complication after FURS holmium laser lithotripsy. We report a case of renal pseudoaneurysm after FURS and holmium laser lithotripsy and review the relevant literature to analyze the possible etiology and summarize the treatment.Case presentationA 29-year-old male with a 2-year history of diabetes was admitted to the hospital because of right back pain for 5 days. A doppler ultrasound demonstrated bilateral renal calculi with bilateral mild hydronephrosis. The patient underwent one-stage right FURS and holmium laser lithotripsy and bilateral ureteral stent implantation. The urine was clear on the second day after the operation, and he was discharged from the hospital. Due to severe gross hematuria, he had to be hospitalized 28 days after the operation. A CT scan showed multiple blood clots in the right renal pelvis and bladder. An emergency blood transfusion and removal of the bladder blood clots and bilateral double J tubes were performed. His urine was clear for one week, and he was discharged from the hospital. He was hospitalized again 47 days after the operation because of fever and hematuria. A CT scan demonstrated blood clots in the bladder and right renal pelvis. Angiography showed a pseudoaneurysm in a small branch of the right renal artery, and hematuria stopped after selective renal artery embolization with microcoils.ConclusionFURS and holmium laser lithotripsy is safe, but we should be aware of the possibility of renal artery pseudoaneurysms (RAP). Through careful operation during the surgery, avoiding kidney injury, reducing intrarenal pressure and controlling the time of operation may prevent the occurrence of this complication. Vascular embolization is the first choice for the treatment of pseudoaneurysms.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Renal Pseudoaneurysms after Flexible Ureteroscopy and Holmium Laser Lithotripsy: A Case Report

Deng

Zhang

et al. 2022

Front. Surg.

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“…Urothelial mucosal damage or cavitation bubbles were suspected. Recently, Durner et al [ 13 ] reported the case of a patient who underwent bridge therapy for underlying disease status after mitral valve replacement. No notable complications were observed during the procedure, but the patient developed macrohematuria after resuming anticoagulant therapy with low-molecular-weight heparin.…”

Section: Discussionmentioning

confidence: 99%

Renal pseudoaneurysm after rigid ureteroscopic lithotripsy: A case report

Li¹,

Lin²,

Hsu³

et al. 2022

WJCC

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BACKGROUND Ureteroscopic lithotripsy (URSL) is a common surgical treatment for ureteral stones. Although flexible ureteroscopy can be used to treat ureteral and renal stones in a single procedure, rigid ureteroscopy can only be used to treat ureteral stones; nonetheless, rigid ureteroscopy remains mainstream in Taiwan owing to its late introduction and flexible ureteroscopy is not covered by national health insurance. Hematuria is a common complication that occurs when the scope passes through stricture sites or when mucosal damage occurs during lithotripsy, but this is usually self-limited. Prolonged hematuria requiring intervention is termed persistent hematuria. Persistent hematuria is less common and few studies have reported the development and etiology of renal pseudoaneurysm after flexible ureteroscopy for renal stones. Herein, we present the first reported case of renal pseudoaneurysm after rigid URSL for ureteral stone. CASE SUMMARY The patient was a 57-year-old man who developed renal pseudoaneurysm with active bleeding after rigid ureteroscopy. He presented with gross hematuria and intolerable left flank pain after left URSL. Severe anemia was noted (hemoglobin level, 6.8 g/dL). Contrast enhanced computed tomography revealed one pseudoaneurysm each in the upper and lower renal cortex. He was managed via transcatheter arterial embolization with microcoils, which relieved the symptoms. CONCLUSION To the best of our knowledge, ours is the first case report on renal pseudoaneurysm after rigid URSL. Because renal pseudoaneurysms are difficult to access, underlying hypertension, clinical signs such as refractory flank pain, and gross hematuria should be carefully monitored following similar endourological procedures.

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“…While the risk of rupture is low, it is associated with high mortality rates reaching 80 % in reported cases and the risk of bleeding increases if the size of the pseudoaneurysm >2cm 3 . Renal artery pseudoaneurysms have been reported in various clinical scenarios, including blunt renal trauma, surgery, percutaneous procedures, and spontaneously secondary to inflammatory or neoplastic processes within the kidney 4 . Patients typically present with flank pain, haematuria or unexplained anemia, although many can be asymptomatic.…”

Section: Discussionmentioning

confidence: 99%

Case – Renal artery pseudoaneurysm: A life-threatening occurrence following thulium laser lithotripsy

Monteiro

Waisanen²,

Ermolovich³

et al. 2021

CUAJ

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Introduction Renal artery pseudoaneurysm post-laser lithotripsy is a rare and potentially life-threatening complication. Traditionally, the most common modalities used for treatment of urinary tract stones were holmium laser lithotripsy and extracorporeal shockwave lithotripsy. However, thulium laser has recently gained momentum in the treatment of urinary tract stones with increasing use and availability in healthcare systems. We report a case of renal artery pseudoaneurysm post-thulium laser lithotripsy who presented in hemorrhagic shock after ureteral stent removal and was subsequently stabilized by endovascular embolization.

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Renal Pseudoaneurysm after Flexible Ureterorenoscopy - An Unusual Complication

Cited by 14 publications

References 8 publications

Renal Pseudoaneurysms after Flexible Ureteroscopy and Holmium Laser Lithotripsy: A Case Report

Renal Pseudoaneurysms after Flexible Ureteroscopy and Holmium Laser Lithotripsy: A Case Report

Renal pseudoaneurysm after rigid ureteroscopic lithotripsy: A case report

Case – Renal artery pseudoaneurysm: A life-threatening occurrence following thulium laser lithotripsy

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