Extracorporeal shock wave lithotripsy of renal calculi in a patient with haemophilia A complicated by a high titre factor VIII inhibitor

Haematuria and urolithiasis in patients with haemophilia

“…Urolithiasis in haemophiliacs has rarely been reported in the literature apart from isolated case reports, evaluating the safety of extracorporial shock wave lithotripsy procedure (ESWL) (7–12). Two patients with urolithiasis were treated (13) – one by ESWL and the other by conventional surgery without any demonstrable difference in factor concentrate usage for confirming haematuria.…”

ESWL in Hemophiliac Patients

“…Alvarez et al [14]even described a case of large perirenal hematoma after ESWL in a patient with unrecognized hemophilia, suggesting that it still must be considered a major intervention. On the other hand, some authors demonstrated the use of ESWL in the treatment of urinary stones in hemophiliacs; however, in all these reports only 1–4 sessions were described [1, 3, 6, 7, 8, 9, 10, 11]. The total energy delivered to patients’ tissues (number and/or energy of impulses) was usually reduced.…”

“…Infusions of 3,500–13,000 units during 1–3 days have been described [1, 3, 10]. Christensen et al [7]presented a patient with mild hemophilia A who was treated without complications and with no substitution, while Leusmann et al [8]performed uncomplicated ESWL in a case with a high factor VIII inhibitor level, using an activated prothrombin complex concentrate [8]. …”

“…Owing to a general tendency in urology to limit the indications for surgical treatment of urolithiasis, attempts were made to apply ESWL [1, 3, 6, 7, 8, 9, 10, 11]and percutaneous nephrolithotripsy [12, 13]in some patients with hemophilia. The procedures were preceded by full or shortened substitution.…”