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

Abstract

Objective: To report the incidence, risk factors, and treatments of renal subcapsular hemorrhage (RSH) complicating ureteroscopic lithotripsy (URSL). Patients and Methods: Data from 1,918 URSLs performed between January 2004 and March 2012 were retrospectively analyzed. Patients' data included age, sex, relevant medical history, stone side, size, and degree of hydronephrosis. Results: All 8 patients were identified as having an RSH after URSL. There were 2 males and 6 females with a mean age of 45.6 years (range 30-62 years). The patients' relevant medical histories (renal calculi extracorporeal shock wave lithotripsy, renal operation and hypertension) were statistically different between those who did and did not develop an RSH. Acute onset of flank pain is the most common symptom. Three patients with infective and large hemorrhage were managed by percutaneous nephrostomy in 1 and percutaneous subcapsular drainage in 2. Five patients with small and uninfected hemorrhage were managed conservatively. Conclusions: The rate of development of RSH complicating URSL is very low. RSH complicating URSL can occur in patients with underlying renal abnormalities. RSH is rarely associated with abrupt hemodynamic instability and usually not lethal. Treatment is selected based on the patient's hemodynamic state, infection, renal function, and the feasibility of treatment modality.

Symptomatic Subcapsular and Perinephric Hematoma Following Ureteroscopic Lithotripsy for Renal Calculi

“…Interestingly, another recent retrospective analysis found a female predominance among their identified SH (six out of eight cases). 13 The effect of ureteral stents and ureteral access sheaths on hematoma formation seems less intuitive, but these measures may instead be surrogates for other factors that are difficult to assess. For instance, preoperative stents are typically placed in the setting of obstruction or ureteral narrowing.…”

Hospital Readmissions Due to Subcapsular Renal Hematoma After Flexible and Rigid Ureterorenoscopy

“…The most common symptoms in patients with SRH include side pain, fever, hematuria, palpable mass, and bloodloss-related symptoms (5,9). All of our patients had side pain and fever.…”

“…The causes of SRH include renal trauma, tumors, vascular diseases, infections, renal cystic diseases, and bleeding disorders (7,8,9). An incidence of lower than 0.4% has been reported following ureterorenoscopy (5,8,10).…”

Huge perinephric hematoma after ureteroscopy and pneumatic lithotripsy for ureteral stone; A life-threatening rare complication: Case report and review of literature

“…The etiology of renal hematomas as a complication of URS and lithotripsy is uncertain yet, nonetheless trauma to the pelvicaliceal system during manipulation of a safety guide wire or forniceal rupture because of increased intrarenal pressure has been reported to facilitate hematoma formation [ 15 , 17 ]. Furthermore, Bai and associates proposed that the increase of intrarenal pressure during the procedure could lead to sudden expansion and rupture of the compressed renal parenchyma and vessels, causing bleeding and hematoma formation [ 10 ].…”