Subcapsular renal haematoma after holmium:yttrium‐aluminum‐garnet laser ureterolithotripsy

Abstract

Study Type – Therapy (case series) Level of Evidence 4 What's known on the subject? and What does the study add? The literature scarcely reports subcapsular renal haematoma (SRH) after lithotripsy techniques. We reported the incidence, associated risk factors, possible pathogenesis, precautions, and outcomes of SRH after ureteroscopic lithotripsy (URSL). OBJECTIVE To report the incidence, risk factors, and outcomes of subcapsular renal haematoma (SRH) after ureteroscopic lithotripsy (URSL) using holmium:yttrium‐aluminum‐garnet (Ho:YAG) laser to treat ureteric stones. PATIENTS AND METHODS Prospective data from 2848 URSLs performed between January 2003 and September 2010 were retrospectively analysed. In all 11 patients were identified as having a SRH after URSL if they had persistent severe ipsilateral flank pain or a palpable mass within a day of surgery, or presented with radiographic evidence of a SRH. Risk factors for the development and course of the SRH were reported. RESULTS Of the 2848 consecutive patients treated with URSL using Ho:YAG laser, 11 (0.4%) developed a SRH after surgery. Patients who developed a SRH had larger stones (1.4 vs 0.9 cm, P < 0.001), more severe ipsilateral hydronephrosis (P < 0.001), longer operation duration (41 vs 33 min, P < 0.001), and higher perfusion pressure of hydraulic irrigation (176.8 vs 170.2 mmHg, P < 0.001) than patients who did not develop a SRH. Patient age, sex, body mass index, presence of diabetes mellitus, history of urolithiasis and hypertension, presence of multiple stones, stone location and flow rate of hydraulic irrigation were not statistically different in patients who did or did not develop a SRH. Most patients were managed conservatively, with no further intervention or with a flank drain, until the SRH resolved. Overall, in three patients the SRH resolved with no further intervention, six patients were treated with a drain only, and two patients had open surgery within a day of presenting with SRH. CONCLUSIONS The rate of development of SRH after URSL is very low. Most patients who present with a SRH after URSL, can be treated conservatively with no intervention or with a drain only.

Renal Subcapsular Hemorrhage Complicating Ureterolithotripsy: An Unknown Complication of a Known Day-to-Day Procedure

“…The incidence of RSHs after URSL in the present series was 0.4%, significantly higher than in those reported in the review by Blute et al [3], significantly lower than in those reported in the review by Bai et al [6]. A possible explanation could be the fact that Bai et al [6] systematically inserted a double J stent, and so did we mostly.…”

“…Some patients have continuous flank pain after placement of a double J stent, and not only during voiding. This could explain the higher incidence of technical investigations and detection of hematoma in our population and in that of Bai et al [6]. …”

“…A possible explanation could be the fact that Bai et al [6] systematically inserted a double J stent, and so did we mostly. Some patients have continuous flank pain after placement of a double J stent, and not only during voiding.…”

“…With the advent of endourology, that term has also been used in ureteroscopy. Although an infrequent event in the endoscopic management of ureteral calculi, with only two published reports [5,6], RSH is a potential serious complication that should always be taken into account when performing such procedures.…”

Lumbar artery branch injury secondary to ureteroscopic manipulation

“…[1][2][3] While both a lumbar artery branch rupture and a SRH can present with unexplained decreasing hematocrit or flank pain, the timing of onset of the symptoms may vary depending on the nature of the injury. Our patient presented with hypotension, tachycardia, and a decreasing hematocrit in the immediate postoperative period due to the severe nature of the hemorrhage; on the …”