Risk Factors for Perinephric Hematoma Formation After Shockwave Lithotripsy: A Matched Case-Control Analysis

Abstract

A clinical PNH occurred in less than 1% of our population. This is consistent with reports from earlier generation devices. Risk factors identified for hematoma formation were intraoperative hypertension and the use of anticoagulant/antiplatelet drugs.

CUA Guideline: Management of ureteral calculi

“…109,110 This is because there is 20-to 40-fold increased risk of peri-renal hematomas and hemorrhagic complications in patients with uncorrected coagulopathies undergoing SWL when compared with patients with a normal bleeding profile. 111,112 Therefore, in consultation with a haematologist or a cardiologist, bleeding coagulopathies need to be corrected and anticoagulation therapy appropriately withheld perioperatively. 113 In addition, patients with increased risk of thromboembolic disease could be managed by bridging with subcutaneous low molecular weight heparin, while oral anticoagulation is held.…”

Techniques: Shockwave lithotripsy may not be a good option in patients with previous renal superselective embolization

“…2 His pre-and intra-SWL blood pressure remained under 130/90 mmHg. 3 The stone was fragmented under fluoroscopic guidance using a Storz Medical Modulith SLX lithotripter (Karl Storz, Tuttlingen, Germany). Three thousand shockwaves were delivered with a dose escalation up to a maximum energy level of 5.…”

“…Risk factors include uncontrolled hypertension, increasing age, body mass index, diabetes mellitus, atherosclerosis, and the number/frequency/intensity of shockwaves. 3,4 The embolization coil within the lower pole of the kidney may have contributed to his peri-renal hematoma. Since the coil from the first embolization was in close proximity to the stone targeted during SWL, the embolization coil was within the path of the shockwaves, which could have caused the coil to migrate or cause damage to adjacent vessels via shear stress.…”

Extracorporeal shock wave lithotripsy in the treatment of renal and ureteral stones

“…Patients with gross hematuria present spontaneous improvement within 48 hours in 85% of cases, and in 10 days, in virtually 100% of cases. 32 Patients with urinary obstruction can be clinically treated with alpha--blockers or surgically through double-J stenting or ure- 33 In a study of 6,172 ESWL sessions, Razvi et al 34 evaluated the risk factors for the development of perirenal hematoma and identified intraoperative hypertension (hazard ratio = 3.3, 95% CI 1.6-10.2, p = 0.03) and use of anticoagulant/ antiplatelet agents (hazard ratio = 4.2, 95% CI 1.1 -15.9, p = 0.03) as significant.…”