Category: Clinical Stones: Ureteroscopy
Introduction & Objective : Subcapsular renal hematomas (SRH) after a ureteroscopic lithotripsy (URSL) is an infrequent complication. The frequency of such complication according to the literature is 0,3 – 0,8%. Our purpose to estimate the frequency and the reason of subcapsular renal hematomas after URSL in patients with various localized ureteral stones.
From 2007 to 2017 in our clinic 1214 URSL with 7,5 and 8,5F rigid ureteroscopy were performed. Clinical information of patients with postoperative symptomatic hematomas after URSL was obtained, including age, sex, previous stone removal operations and comorbidity (diabetes mellitus, an idiopathic hypertension), initial kidney function, the characteristics of stones and degree of a hydronephrosis. The symptoms of postoperative period, results of laboratory tests, ultrasound and CT data of kidneys were also analyzed.
Subcapsular hematomas after ureteroscopy were diagnosed in 4 of 1214 (0,3%) patients aged from 36 up to 65 years. Preoperative examination has shown that all 4 patients had obstructive stones of upper ureter with stone size from 0,8 to 1,2 cm. Previous operations in upper urinary tract were performed in three of these patients: in 2 of them – URSL, one patient aged 54 with a single left kidney was treated twice with percutaneous nephrolithotripsy. Ureteral stenting after URSL was carried out in all patients. All 4 patients had a triad of symptoms: flank pain, fever and reliable decrease of hemoglobin which resulted in a blood transfusion. Hematoma was diagnosed in three patients after 2-3 days of operation, in one female patient - after 2 weeks of operation. Two patients were carried out conservatively by using bed rest and antibiotics. These patients have recovered. In one case the puncture and drainage of a hematoma under ultrasound monitoring were performed. In patient with a single kidney due to increasing of hematoma and renal failure symptoms laparoscopic decapsulation of a kidney with a drainage of a hematoma was made. The blood transfusion was carried out in two patients. Dynamic CT has shown the complete resolution of hematomas in all cases.
Conclusions : Subcapsular kidney hematoma is an infrequent but potentially serious complication of URSL. Flank pain and fever in postoperative period can be symptoms of this complication, which can be confirmed by kidney ultrasound. Treatment of subcapsular hematoma must be individual depending on severity of each clinical case.
Bakhman Guliev– Urology department, ass. of prof, North West medical university by Mechnikov, St Petersburg, Saint Petersburg City, Russia
Boris Komyakov– , St Petersburg, Saint Petersburg City, Russia
Arthur Zaikin– , St Petersburg, Saint Petersburg City, Russia
Urology department, ass. of prof
North West medical university by Mechnikov
St Petersburg, Saint Petersburg City, Russia