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He M, Dong Y, Cai W, Cai J, Xie Y, Yu M, Li C, Wen L. Recent advances in the treatment of renal stones using flexible ureteroscopys. Int J Surg 2024; 110:4320-4328. [PMID: 38477158 PMCID: PMC11254199 DOI: 10.1097/js9.0000000000001345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 03/04/2024] [Indexed: 03/14/2024]
Abstract
Upper urinary tract stones are a common urological disease that can be treated by flexible ureteroscopy (FURS) through the natural urinary tract, in addition to extracorporeal shock wave lithotripsy and percutaneous nephrolithotomy. The advantages of FURS are less trauma, faster recovery, and fewer complications, while its disadvantages include poor results of lithotripsy and stone extraction when dealing with larger stones, and prolonged operation time. Over the last two decades, the emergence of new technologies such as FURS combined with negative pressure suction, robot-assisted FURS, and artificially intelligent FURS, coupled with improvements in laser technology (the use of thulium fiber lasers and the invention of single-use flexible ureteroscopes (su-fURS) suitable for primary level application, have significantly increased the global adoption of FURS. This surge in usage holds a promising future in clinical application, benefiting a growing number of patients with renal calculi. Accompanied by changes in technical concepts and therapeutic modalities, the scope of indications for FURS is broadening, positioning it as a potential primary choice for urolithiasis treatment in the future. This review outlines the progress in employing FURS for the treatment of renal calculi in order to generate insights for further research.
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Affiliation(s)
- Min He
- School of the Second Clinical Medical College, Zhejiang Chinese Medical University
- First People’s Hospital of Fuyang
| | - Yonghui Dong
- School of the Second Clinical Medical College, Zhejiang Chinese Medical University
- Department of Urology, Affiliated Hangzhou First People’s Hospital, School of Medicine, Westlake University
| | | | - Jiale Cai
- School of the Second Clinical Medical College, Zhejiang Chinese Medical University
- First People’s Hospital of Fuyang
| | - Yaming Xie
- General Surgery, Department of Hepatobiliary and Pancreatic Surgery and Minimal Invasive Surgery, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital), Hangzhou Medical College
| | - Mingke Yu
- Zhejiang Provincial Hospital of Chinese Medicine, Hangzhou, Zhejiang Province, People’s Republic of China
| | - Changjiu Li
- Department of Urology, Affiliated Hangzhou First People’s Hospital, School of Medicine, Westlake University
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Deka H, Mathew G, Sanjeevan KV. Subcapsular hematoma following retrograde intrarenal surgery: a rare complication. AFRICAN JOURNAL OF UROLOGY 2023. [DOI: 10.1186/s12301-023-00337-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023] Open
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Mustafa M, Al Zabadi H, Mansour S, Nabulsi A. Endoscopic Management of Upper and Lower Ureteric Stones Using Pneumatic Lithotripter: A Retrospective Medical Records Review. Res Rep Urol 2023; 15:77-83. [PMID: 36818496 PMCID: PMC9930580 DOI: 10.2147/rru.s392881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 12/23/2022] [Indexed: 02/13/2023] Open
Abstract
Background In this study we aimed to assess and compare the rate of sem-irigid ureterorenoscope in the treatment of upper and lower ureter stones through pneumatic lithotripsy (PL). Materials and Methods Ninety-two patients with a mean age±SD of 45±15years who had had a surgical procedure performed by the same experienced surgeon between January 2013 and July 2015 were included in the study. The mean±SD stone size was 8.8±2.6 mm. Forty-two of the patients (45.7%) had upper ureter stones and 50 (54.3%) had lower ureter stones in order to increase the success rate and avoid stone migration. The medical files of the patients were reviewed regarding age, sex, stone size, stone location, success rate, complications, and presence of hydronephrosis. Success was operationally defined as the complete fragmentation of stone to very small parts that could pass or complete extraction of the stone. Results Eighty-four of the patients were stone free (91%). The success rates for patients with upper or lower ureteric stones were 93% and 90%, respectively (P=0.63). There were no complications during the operation. However, 4 patients (4.4%) had postoperative complications in terms of urinary tract infection or urosepsis. Those were accurately managed by the suitable medical treatment. Conclusion Semi-rigid ureterorenoscopy by using PL was a safe and practical treatment option for managing the upper and lower ureter stones. Performing the tips and tricks of ureterorenoscopy by an experienced surgeon seems to enhance the success rate, especially in upper ureter stones.
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Affiliation(s)
- Mahmoud Mustafa
- Department of Urology, An-Najah National University Hospital, An-Najah National University, Nablus, Palestine,Medicine Department, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine,Correspondence: Mahmoud Mustafa, Department of Urology, An-Najah National University Hospital, An-Najah National University, Nablus, Palestine, Email
| | - Hamzeh Al Zabadi
- Public Health Department, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine,Hamzeh Al Zabadi, Public Health Department, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine, Email
| | - Shaden Mansour
- Department of Urology, An-Najah National University Hospital, An-Najah National University, Nablus, Palestine
| | - Aya Nabulsi
- Department of Urology, An-Najah National University Hospital, An-Najah National University, Nablus, Palestine
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Yu J, Li B, Ren BX, Zhang NY, Jin BX, Zhang JJ. Subcapsular renal haematoma after ureteroscopic lithotripsy: a single-centre, retrospective study in China. BMJ Open 2022; 12:e062866. [PMID: 36351717 PMCID: PMC9644328 DOI: 10.1136/bmjopen-2022-062866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVES To investigate the incidence, predisposing factors, diagnosis and management of subcapsular renal haematoma (SRH) after ureteroscopic lithotripsy (URSL). DESIGN Retrospective observational study. SETTING Shandong Provincial Hospital, a 4500-bed tertiary hospital in China. PARTICIPANTS The data from 1535 consecutive patients treated with URSL (including rigid URSL and flexible URSL) between January 2015 and October 2020 were retrospectively analysed. MAIN OUTCOME MEASURES SRH after URSL confirmed via CT. The characteristics, operative data and outcomes of these patients were documented and compared. RESULTS Six patients were confirmed to have an SRH after URSL on CT. The total incidence of SRH after URSL was 0.39%. The incidences of SRH after rigid URSL and flexible URSL were 0.38% and 0.41%, respectively. Unendurable ipsilateral flank pain and a significant decrease in haemoglobin after surgery were the typical clinical manifestations of SRH after URSL. There were no significant differences in age, sex, history of diabetes mellitus, preoperative hypertension, body mass index, stone laterality or perfusion pressure (p>0.05). However, SRH was significantly associated with the stone size, stone location, degree of hydronephrosis and operative duration (p<0.01). One patient was managed conservatively without further intervention, percutaneous drainage was performed in four patients and one patient underwent emergency angiography. No patients died of SRH. CONCLUSIONS SRH is a rare but potentially serious complication of URSL. Severe hydronephrosis and a thin renal cortex preoperatively and prolonged operative duration are strong predisposing factors for SRH. Laparoscopic ureterolithotomy should be considered as an alternative surgery for patients with severe ureteral tortuosity. SRH is treated based on patients' clinical manifestations. Most patients can be managed with conservative treatment or percutaneous drainage alone.
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Affiliation(s)
- Jiang Yu
- Urology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
- Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Bin Li
- Urology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Bin Xiang Ren
- Urology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Nan Yi Zhang
- Urology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Bo Xun Jin
- Urology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Jun Jian Zhang
- Urology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
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Kovacic J, Latif E. Iatrogenic Renal Rupture in Conduitoscopy - A Diagnostic Trauma. JOURNAL OF UROLOGICAL SURGERY 2022. [DOI: 10.4274/jus.galenos.2021.2021.0089] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
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Harada N, Yatsuda J, Kurahashi R, Fukushima Y, Segawa T, Motoshima T, Murakami Y, Yamaguchi T, Sugiyama Y, Kamba T. Subcapsular renal hematoma after ureterorenoscopy. IJU Case Rep 2022; 5:281-285. [PMID: 35795110 PMCID: PMC9249645 DOI: 10.1002/iju5.12464] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 04/23/2022] [Indexed: 11/12/2022] Open
Abstract
Introduction Subcapsular renal hematoma after ureterorenoscopy using a holmium yttrium‐aluminum‐garnet laser is a rare complication. We experienced a case of subcapsular hematoma after ureterorenoscopy. Case presentation The patient was a 56‐year‐old man with a history of hypertension and coronary vasospastic angina, and he was taking antiplatelet drugs. He had the middle and lower calyx stones measured 36 mm in diameter of the right kidney. We performed ureterorenoscopy, which was completed about 2 h without intraoperative complications. We could not remove the stone completely. After the surgery, the patient developed a fever and complained of right back pain. Computed tomography showed several residual stones formed a stone street, obstructing the stent and resulting in grade 3 hydronephrosis. Furthermore, the right subcapsular renal hematoma infection had detected. Percutaneous hematoma drainage and percutaneous nephrostomy were performed. Conclusion Subcapsular renal hematoma after ureterorenoscopy is an uncommon complication but should be kept in mind.
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Affiliation(s)
- Narumi Harada
- Department of Urology Kumamoto University Kumamoto Japan
| | - Junji Yatsuda
- Department of Urology Kumamoto University Kumamoto Japan
| | | | - Yumi Fukushima
- Department of Urology Kumamoto University Kumamoto Japan
| | - Takuya Segawa
- Department of Urology Kumamoto University Kumamoto Japan
| | | | - Yoji Murakami
- Department of Urology Kumamoto University Kumamoto Japan
| | | | | | - Tomomi Kamba
- Department of Urology Kumamoto University Kumamoto Japan
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Shrestha A, Gharti BB, Adhikari B. Perirenal Extravasation After Retrograde Intrarenal Surgery for Renal Stones: A Prospective Study. Cureus 2022; 14:e21283. [PMID: 35186546 PMCID: PMC8845086 DOI: 10.7759/cureus.21283] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/16/2022] [Indexed: 01/02/2023] Open
Abstract
Background The incidence and consequences of the perirenal extravasation of the irrigation fluid during retrograde intrarenal surgery (RIRS) are not fully elucidated. The objective of this study was to assess the incidence, risk factors, and complications of perirenal extravasation of irrigation fluid during RIRS. Methods This prospective observational study was conducted in the Department of Urology, Bir Hospital, Kathmandu, Nepal, from January 2020 to March 2021. Patients undergoing RIRS for renal stones less than 2 cm in diameter were included in the study. Irrigation during the procedure was performed using isotonic normal saline under gravity at 50 cm from the symphysis pubis of patients with intermittent manual compression if required. Lithotripsy was performed with 120-Watt Ho:YAG laser using 200-micron laser fiber. Retrograde pyelogram was performed after the completion of lithotripsy to document the presence or absence of extravasation on fluoroscopic images. A double-J stent was placed at the end in all patients. Patients were observed for systemic inflammatory response syndrome (SIRS) features. Postoperative abdominal ultrasonography was performed on the first postoperative day to assess the perirenal collection together with complete blood count. The visual analogue scale (VAS) was used to assess pain in postoperative period. The preoperative patient’s and stone characteristics, hydronephrosis, intraoperative characteristics, and postoperative findings were analyzed. Results A total of 71 patients who underwent RIRS during the study period were analyzed. The mean (SD) stone size was 13.19 (3.12) mm. Intraoperative perirenal extravasation of contrast was noted in eight (11.26%) patients; however, no patient had ipsilateral perirenal collection on ultrasonography obtained on the first postoperative day. No significant differences were observed among patients with or without perirenal extravasation in terms of mean stone size, laser settings, operative duration, and lasing duration. Use of ureteral access sheath (UAS) was associated with lower incidence of extravasation; however, it was not significant. SIRS was documented in eight patients overall, with none of the patients with extravasation having features of SIRS. Patients with extravasation experienced more postoperative flank pain (p<0.05). Conclusion Perirenal extravasation was common during RIRS and was associated with higher postoperative pain scores. Stone size, use of UAS, laser settings, operative duration, and lasing duration were not associated with an increased risk of extravasation. Extravasation was not associated with increased postoperative complications.
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Affiliation(s)
- Anil Shrestha
- Department of Urology, Bir Hospital, National Academy of Medical Sciences, Kathmandu, NPL
| | - Binod B Gharti
- Department of Urology, Bir Hospital, National Academy of Medical Sciences, Kathmandu, NPL
| | - Baikuntha Adhikari
- Department of Urology, Bir Hospital, National Academy of Medical Sciences, Kathmandu, NPL
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Bhanot R, Pietropaolo A, Tokas T, Kallidonis P, Skolarikos A, Keller EX, De Coninck V, Traxer O, Gozen A, Sarica K, Whitehurst L, Somani BK. Predictors and Strategies to Avoid Mortality Following Ureteroscopy for Stone Disease: A Systematic Review from European Association of Urologists Sections of Urolithiasis (EULIS) and Uro-technology (ESUT). Eur Urol Focus 2021; 8:598-607. [PMID: 33674255 DOI: 10.1016/j.euf.2021.02.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 02/03/2021] [Accepted: 02/18/2021] [Indexed: 01/29/2023]
Abstract
CONTEXT While kidney stone disease is common and ureteroscopy (URS) is perceived as minimally invasive, there is mortality associated with treatment. OBJECTIVE The aim of this review was to ascertain the number of mortalities from URS for stone disease over the past three decades, identify relevant patient risk factors and predictors of mortality, and summarise the key recommendations so that similar instances can be avoided, and lessons can be learnt. EVIDENCE ACQUISITION A systematic literature search was conducted following Cochrane and Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) methodology for English-language article reporting on data from 1990 to December 2020. Data collated from each study included patient and stone characteristics, number of mortalities, and cause of death. EVIDENCE SYNTHESIS Fifteen studies met our inclusion criteria and revealed a total of 72 mortalities from ten countries. The age range of reported patients varied from 21 to 89 yr, with over 60% being above 65 yr of age and 97% with some comorbidity. Based on available data, death reports in females were three times more than those in males. The stone size ranged from 10 to 38 mm. Treatment of larger stones corresponded to a longer operative time, with procedural duration varying from 30 to 120 min. Of the reported causes of mortality in 42 patients, the aetiology was sepsis in over half of the patients, with other causes being cardiac-related, respiratory-related, multiorgan failure, and haemorrhagic complications. CONCLUSIONS Although the reported URS mortality rate seems to be low, there has been a rise in deaths over the past decade. Efforts must be made to have preoperative urine culture, and reduce operative time and stage procedures in patients with a large stone burden. Care must be taken in patients with robust preoperative assessment, intraoperative techniques, and postoperative monitoring for early detection of complications with interdisciplinary management of complex cases. PATIENT SUMMARY We reviewed the risk factors associated with postureteroscopy mortality and ways to minimise this. Evidence shows that although reported mortality remains low, there seems to be an increase in mortality in the past decade and urologists must remain vigilant of this.
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Affiliation(s)
- Radhika Bhanot
- University Hospital Southampton NHS Trust, Southampton, UK
| | | | - Theodoros Tokas
- Department of Urology and Andrology, General Hospital Hall i.T., Hall in Tirol, Austria; Training and Research in Urological Surgery and Technology (T.R.U.S.T.)-Group
| | | | | | | | | | - Olivier Traxer
- GRC n°20 LITHIASE RENALE, AP-HP, Hôpital Tenon, Sorbonne Université, Paris, France
| | - Ali Gozen
- Medical Clinic Heilbronn, University of Heidelberg, Heidelberg, Germany
| | - Kemal Sarica
- Department of Urology, Medical School, Biruni University, Istanbul, Turkey
| | | | - Bhaskar K Somani
- University Hospital Southampton NHS Trust, Southampton, UK; Manipal Academy of Higher Education, Manipal, India.
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Alrabadi A, Mansi H, Alhamss S, Al Demour S, Odeh M. Huge perinephric hematoma after ureteroscopy and pneumatic lithotripsy for ureteral stone; A life-threatening rare complication: Case report and review of literature. Int J Surg Case Rep 2020; 75:357-360. [PMID: 32980708 PMCID: PMC7522537 DOI: 10.1016/j.ijscr.2020.09.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 09/05/2020] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Ureteroscopy with pneumatic lithotripsy is a relatively safe procedure for the management of the ureteral stone disease. However; subcapsular hematoma and even huge perinephric hematoma are potentially serious events that may complicate this procedure and must be kept in mind. CASE PRESENTATION We present a case of huge perinephric hematoma post ureteroscopy and pneumatic lithotripsy for an impacted ureteral stone. CONCLUSION The occurrence of such a rare complication in a relatively safe procedure must be taken into consideration especially while dealing with patients with long-standing obstruction and thin renal cortex. Furthermore, the risk of bleeding should be included in risk-benefit counselling before ureteroscopic lithotripsy.
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Affiliation(s)
- Adel Alrabadi
- Department of Special Surgery/Division of Urology, The University of Jordan, School of Medicine, Amman, Jordan.
| | - Hammam Mansi
- Department of Special Surgery/Division of Urology, The University of Jordan, School of Medicine, Amman, Jordan
| | - Sohaib Alhamss
- Department of Special Surgery/Division of Urology, The University of Jordan, School of Medicine, Amman, Jordan
| | - Saddam Al Demour
- Department of Special Surgery/Division of Urology, The University of Jordan, School of Medicine, Amman, Jordan
| | - Mahmoud Odeh
- Department of Special Surgery/Division of Urology, The University of Jordan, School of Medicine, Amman, Jordan
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Liu WZ, Huang T, Fang L, Cheng Y. Renal arteriovenous fistula after retrograde ureteroscopic lithotripsy for the lower ureteral stones: a rare case report. BMC Urol 2020; 20:123. [PMID: 32799844 PMCID: PMC7429886 DOI: 10.1186/s12894-020-00688-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Accepted: 07/29/2020] [Indexed: 12/03/2022] Open
Abstract
Background Renal arteriovenous fistula was rarely reported in retrograde endoscopic procedure. Up to now, there is still an absence of report on the formation of renal arteriovenous fistula after semi-rigid ureteroscopic lithotripsy for lower ureteral stones. Case presentation An 83-year-old man was admitted to our hospital complaining about intermittent left flank pain that had persisted for 1 week. He suffered medium hypertension and nephrolithiasis treated with left open ureterolithotomy and two ureteroscopic lithotripsies. Non-contrast abdominal CT scan revealed two left lower ureteral stones diametered 8 mm and 7 mm respectively with mild hydronephrosis. A retrograde semi-rigid ureteroscopic lithotripsy was performed to remove the stones, after which two Double-J stents were placed for the ureteral stricture. Due to the continuous gross hematuria and hemoglobin droppings 2 days after operation, a variety of conservative therapies, including blood transfusion and bed rest, were adopted. Then, the patient was discharged with a stable hemoglobin. However, he presented himself to our emergency department with aggravating left flank pain and severe gross hematuria as little as 2 days later. Emergent digital subtraction angiography was conducted to reveal an arteriovenous fistula in the left kidney, which was embolized with two platinum coils to stop the bleeding. His hematuria was resolved in 3 days, and two Double-J stents were removed in 4 weeks. The patient was followed up for 1 year, during which no hematuria or flank pain recurred. Conclusion This is the first case report on the formation of renal arteriovenous fistula after semi-rigid ureteroscopic lithotripsy. In this case, elevated intrapelvic pressure, historical surgery and hydronephrosis might be associated with the primary risk of the complication.
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Affiliation(s)
- Wan-Zhang Liu
- Department of Urology, NingBo First Hospital, NingBo Hospital of ZheJiang University, #59 Liuting Street, NingBo City, 315000, Zhejiang Province, China
| | - Ting Huang
- Department of Urology, NingBo First Hospital, NingBo Hospital of ZheJiang University, #59 Liuting Street, NingBo City, 315000, Zhejiang Province, China
| | - Li Fang
- Department of Urology, NingBo First Hospital, NingBo Hospital of ZheJiang University, #59 Liuting Street, NingBo City, 315000, Zhejiang Province, China
| | - Yue Cheng
- Department of Urology, NingBo First Hospital, NingBo Hospital of ZheJiang University, #59 Liuting Street, NingBo City, 315000, Zhejiang Province, China.
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Complications of ureteroscopy: a complete overview. World J Urol 2019; 38:2147-2166. [DOI: 10.1007/s00345-019-03012-1] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Accepted: 11/05/2019] [Indexed: 12/18/2022] Open
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Blas L, Roberti J, Ringa MD, Contreras P, Ameri CA. Large Hepatic Subcapsular Hematoma Secondary to Double-J Stent Placement. J Endourol Case Rep 2019; 5:85-87. [PMID: 31501773 DOI: 10.1089/cren.2019.0017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Introduction and Background: Urinary diversion with the endoscopic Double-J stent is a frequent procedure; complications can include irritation, suprapubic or flank pain, vesicoureteral reflux, hematuria, or urinary infection. We report a case of hepatic subcapsular hematoma secondary to Double-J stent placement. Case Presentation: A 28-year-old woman presented with a history of Sjögren's disease, nephrocalcinosis, and chronic kidney disease (CKD). The patient underwent multiple percutaneous and endoscopic procedures during the previous 2 years: right kidney: extracorporeal shock wave lithotripsy (SWL) × 4, ureteroscopic lithotripsy × 2, percutaneous nephrolithotomy (PCNL), and retrograde intrarenal surgery; left kidney: SWL × 2, ureteroscopic lithotripsy × 5, and PCNL. Ultrasound imaging showed severe dilation in the right kidney and moderate dilation in the left kidney. CT scanning without contrast revealed a right pyelourethral dilation caused by a 13 mm ureteral lithiasis; also, cortical atrophy was observed. Urosepsis with exacerbated CKD was diagnosed and bilateral 7F Double-J stents were placed on both sides under general anesthesia. On postoperative day (POD) 8, the patient presented with pain in the right hemithorax and dullness to percussion. CT scans showed a heterogeneous hepatic subcapsular collection, of 15 × 7 × 23 cm, of hematic aspect, displacing vascular structures, and no active bleeding. Treatment was expectant and symptomatic. On POD 16, a new CT scan ruled out progression of the hematoma. The patient was finally discharged on POD 19. Four months later, bilateral semirigid ureteroscopy showed a right ureteral lithiasis of 8 × 7 mm, which was fragmented with a holmium laser. Nineteen months after the first episode, the patient is asymptomatic, with no residual lithiasis or hepatic hematoma. Conclusion: This case shows a very rare complication of Double-J stent placement that could be managed by conservative treatment.
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Affiliation(s)
- Leandro Blas
- Hospital Alemán de Buenos Aires, Buenos Aires, Argentina
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Kaler KS, Cooper V, O'Leary M, Valley ZA, Lee TK, Patel RM, Landman J, Clayman RV. Laser Endoscopic X-Ray-Guided Intrarenal Tract: Comparison Among Renal Access Modalities in the Porcine Kidney. J Endourol 2019; 33:719-724. [PMID: 31184211 DOI: 10.1089/end.2019.0234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Introduction and Objectives: Laser endoscopic X-ray-guided intrarenal tract (LEXIT) is a recently described holmium laser retrograde access technique for creating percutaneous access during a percutaneous nephrolithotomy. We compared bleeding, ease of access, and the time to achieve access for each of the following three modalities: LEXIT, retrograde Lawson puncture wire, and antegrade 18-gauge nephrostomy needle access in the porcine kidney. Methods: Eight pigs underwent an average of five nephrostomy accesses per kidney under simultaneous laparoscopic vision at 5 mm Hg insufflation pressure. Data collected included: access time (seconds), bleeding intensity (scale: 1 [no bleeding] - 10 [severe bleeding]), bleeding duration (seconds), accuracy of caliceal entry, and surgeon comfort with the technique (scale: 1 [very easy] - 10 [very difficult]). Results: A total of 64 nephrostomy accesses were obtained. The speed of nephrostomy access with LEXIT was significantly faster than the nephrostomy needle and Lawson wire (p < 0.001). Bleeding intensity (p = 0.002) and severity (p = 0.001) were lower with the Lawson puncture wire, followed by LEXIT and then by the nephrostomy needle. LEXIT was rated as easier in acquiring access within the upper pole (p = 0.003) and interpolar calices (p < 0.001). Histopathology demonstrated no difference in parenchymal damage between LEXIT and nephrostomy needle (p = 0.18); however, LEXIT was associated with significantly increased peri-tract thermal injury, although within a narrow focus of 1.6 mm (p < 0.01). Conclusion: Among the three renal access techniques, LEXIT provided the fastest access times and greatest ease of access specifically for upper pole and interpolar calices. Also, bleeding with LEXIT was significantly less compared with the standard antegrade nephrostomy needle access. Histopathological analysis demonstrated that the holmium laser resulted in focal thermal tissue effects similar in range to the blunt tissue trauma caused by the 18-gauge nephrostomy needle.
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Affiliation(s)
- Kamaljot S Kaler
- Department of Urology, University of California, Irvine, California
- Department of Surgery, Section of Urology, University of Calgary, Calgary, Canada
| | - Vinay Cooper
- Department of Urology, University of California, Irvine, California
| | - Mitchell O'Leary
- Department of Urology, University of California, Irvine, California
| | - Zachary A Valley
- Department of Urology, University of California, Irvine, California
| | - Thomas K Lee
- Department of Urology, University of California, Irvine, California
| | - Roshan M Patel
- Department of Urology, University of California, Irvine, California
| | - Jaime Landman
- Department of Urology, University of California, Irvine, California
| | - Ralph V Clayman
- Department of Urology, University of California, Irvine, California
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Akbani S, Wolf JS, Osterberg EC. Enterorenal Fistula as an Unusual Complication from Ureteroscopic Lithotripsy: A Case Report. J Endourol Case Rep 2019; 5:49-52. [PMID: 31179384 PMCID: PMC6555179 DOI: 10.1089/cren.2018.0102] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: This case highlights an enterorenal fistula as a rare complication from ureteroscopic lithotripsy. Case Presentation: A 56-year-old woman with significant obesity, decompensated cirrhotic and ascitic liver disease, hypertension, type 2 diabetes mellitus, and nephrolithiasis treated with five prior ureteroscopic lithotripsies for a partial left staghorn stone presented to the emergency department (ED) with worsening left flank pain and sepsis. A CT scan of the abdomen and pelvis with contrast showed a large left perinephric hematoma. She underwent drain placement and during fluoroscopic imaging, there was a fistula from the left subcapsular hematoma/abscess to the proximal descending colon. The patient wished to proceed with a surgical course involving nephrectomy with hemicolectomy despite extensive counseling regarding her high mortality risk. However, because of worsening nutritional status as well as several other high-risk comorbidities, a shared decision was made with the patient to postpone the procedure. The patient was discharged to a skilled nursing facility for nutritional optimization and prehabilitation; however, she continued to decline with recurrent sepsis and cirrhosis-related complications and unfortunately passed away. Conclusion: A subscapular hematoma evolving into a perinephric abscess is a rare but known complication of ureteroscopic lithotripsy; however, this patient developed an enterorenal fistula that has yet to be reported after repeated ureteroscopy.
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Affiliation(s)
- Sabah Akbani
- Department of Surgery and Perioperative Care, Division of Urology, Dell Medical School at the University of Texas at Austin, Austin, Texas
| | - J Stuart Wolf
- Department of Surgery and Perioperative Care, Division of Urology, Dell Medical School at the University of Texas at Austin, Austin, Texas
| | - E Charles Osterberg
- Department of Surgery and Perioperative Care, Division of Urology, Dell Medical School at the University of Texas at Austin, Austin, Texas
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Nazer A, Awwad AA, Aljuhayman A, Alasker A, Bin Hamri S. Stone fragments migration into subcapsular renal hematoma post flexible ureterorenoscopy (unique presentation). J Surg Case Rep 2019; 2019:rjz125. [PMID: 31065335 PMCID: PMC6498882 DOI: 10.1093/jscr/rjz125] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 04/04/2019] [Accepted: 04/26/2019] [Indexed: 11/22/2022] Open
Abstract
This is a case report of 45-year-old female patient who presented with right flank pain. Abdominopelvic CT scan showed right renal pelvis stone measuring 20 mm. Right flexible ureterorenoscopy with holmium laser was performed in our institute. Postoperatively, she was febrile and pale. Immediate Abdominopelvic CT scan was obtained which revealed a large right subcapular hematoma. Conservative management was maintained for a week. Two months later, repeated Abdominopelvic CT scan showed regression of right subcapsular renal hematoma with stone fragments migration into the perinephric space as a first presentation in the world.
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Affiliation(s)
- Ahmed Nazer
- Urology Division, King Abdul Aziz Medical City National Guard Hospital, Riyadh 12225-8984, Saudi Arabia
| | - Ahmed Al Awwad
- Urology Division, King Abdul Aziz Medical City National Guard Hospital, Riyadh 12145-3704, Saudi Arabia
| | - Ahmed Aljuhayman
- Urology Division, King Abdul Aziz Medical City National Guard Hospital, Riyadh 13455-8704, Saudi Arabia
| | - Ahmed Alasker
- Urology Division, King Abdul Aziz Medical City National Guard Hospital, Riyadh 11045-5299, Saudi Arabia
| | - Saeed Bin Hamri
- King Abdulaziz National Guard Hospital, Riyadh 2247, Saudi Arabia
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[A CASE OF RETROPERITONEAL HEMORRHAGE CAUSED BY THE INSERTION OF A URETERAL ACCESS SHEATH. A RARE COMPLICATION ASSOCIATED WITH FLEXIBLE TRANSURETHRAL LITHOTRIPSY (fTUL)]. Nihon Hinyokika Gakkai Zasshi 2019; 109:50-53. [PMID: 30662053 DOI: 10.5980/jpnjurol.109.50] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
A 77-year-old man with a right kidney stone was admitted to our hospital. A ureteroscope was introduced into the ureter without dilation under direct vision. We then performed flexible transurethral lithotripsy (f-TUL) using a ureteral access sheath and successfully fragmented the stone and extracted almost all the stone fragments without any complications. Just 3 hours after the operation, he suddenly developed right abdominal pain with a decrease in hemoglobin. A CT scan showed a retroperitoneal hemorrhage around the lower ureter. We herein describe a rare complication associated with flexible transurethral lithotripsy.
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17
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Campobasso D, Grande M, Ferretti S, Moretti M, Facchini F, Larosa M, Salsi P, Granelli P, Pozzoli GL, Frattini A. Subcapsular renal hematoma after retrograde ureterorenoscopic lithotripsy: our experience. MINERVA UROL NEFROL 2018; 70:617-623. [PMID: 30037212 DOI: 10.23736/s0393-2249.18.03199-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Ureterorenoscopy is the current standard treatment for ureteral and kidney stones, also stones greater than 2 cm can be removed. Complications linked to infectious processes or ureteral damage are the most frequently reported. Subcapsular renal hematoma is an extremely rare complication following this procedure. METHODS We report the retrospective experience of two urological referral units for stones disease by analyzing incidence, risk factors and management of subcapsular renal hematoma. RESULTS Between May 2011 and December 2017, 2497 consecutive ureteroscopies for urolithiasis were performed by 8 skilled endourologists. A subcapsular renal hematoma was diagnosed in four cases (0.12%). Symptoms appeared few hours after intervention in two patients and after 14 postoperative days in the remaining two. In all cases CT scan revealed a subcapsular renal hematoma without signs of active bleeding. Conservative treatment was successful. Two patients required blood transfusion. One patient developed renal hypotrophy. CONCLUSIONS Subcapsular renal hematoma represents a rare but potentially serious complication after ureterorenoscopic lithotripsy. Its real incidence and etiology still need to be clarified. The elevated intrarenal pressures play an important role. Persistent hematuria, flank pain and hemoglobin drop should guide prompt investigation to reach an early diagnosis. In most cases a conservative management is sufficient.
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Affiliation(s)
- Davide Campobasso
- Unit of Urology, Civil Hospital of Guastalla, AUSL Reggio Emilia, Reggio Emilia, Italy -
| | - Marco Grande
- Unit of Urology, Civil Hospital of Guastalla, AUSL Reggio Emilia, Reggio Emilia, Italy
| | - Stefania Ferretti
- Service of Endourology and Mini-invasive Percutaneous Surgery, Unit of Urology, Parma University Hospital, Parma, Italy
| | - Matteo Moretti
- Unit of Urology, Civil Hospital of Guastalla, AUSL Reggio Emilia, Reggio Emilia, Italy
| | - Francesco Facchini
- Unit of Urology, Civil Hospital of Guastalla, AUSL Reggio Emilia, Reggio Emilia, Italy
| | - Michelangelo Larosa
- Unit of Urology, Civil Hospital of Guastalla, AUSL Reggio Emilia, Reggio Emilia, Italy
| | - Paolo Salsi
- Service of Endourology and Mini-invasive Percutaneous Surgery, Unit of Urology, Parma University Hospital, Parma, Italy
| | - Pietro Granelli
- Service of Endourology and Mini-invasive Percutaneous Surgery, Unit of Urology, Parma University Hospital, Parma, Italy
| | - Gian Luigi Pozzoli
- Unit of Urology, Civil Hospital of Guastalla, AUSL Reggio Emilia, Reggio Emilia, Italy
| | - Antonio Frattini
- Unit of Urology, Civil Hospital of Guastalla, AUSL Reggio Emilia, Reggio Emilia, Italy
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18
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Inoue T, Okada S, Hamamoto S, Yoshida T, Matsuda T. Current trends and pitfalls in endoscopic treatment of urolithiasis. Int J Urol 2017; 25:121-133. [DOI: 10.1111/iju.13491] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Accepted: 10/12/2017] [Indexed: 12/19/2022]
Affiliation(s)
- Takaaki Inoue
- Department of Urology and Andrology; Kansai Medical University; Hirakata Osaka Japan
| | - Shinsuke Okada
- Department of Urology; Gyotoku General Hospital; Ichikawa Chiba Japan
| | - Shuzo Hamamoto
- Department of Urology; Medical School; Nagoya City University Graduate School of Medical Sciences; Nagoya Aichi Japan
| | - Takashi Yoshida
- Department of Urology and Andrology; Kansai Medical University; Hirakata Osaka Japan
| | - Tadashi Matsuda
- Department of Urology and Andrology; Kansai Medical University; Hirakata Osaka Japan
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19
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Abstract
INTRODUCTION With the broadening indications of ureteroscopy (URS) for complex stones and high-risk patients, more URS is being performed and hence there is an increasing risk of major potentially life-threatening complications. We wanted to define the incidence, predisposing factors, management, and long-term sequelae for post-URS perirenal hematoma (PRH). MATERIAL AND METHODS We conducted a systematic review of literature according to Cochrane and preferred reporting items for systematic reviews and meta-analysis guidelines for all studies reporting on post-URS PRH from 1980 to September 2016. A literature search was conducted through PubMed, EMBASE, CINAHL, and Cochrane Library for all English language articles. RESULTS Based on a literature search of 210 articles, seven studies (8929 patients) met the inclusion criteria with an incidence of post-URS PRH reported as 0.45% (40 patients, range: 0.15%-8.9% per study) with a mean age of 53 years and a mean stone size of 1.7 cm. The predisposing factors were moderate-severe hydronephrosis, thin renal cortex, prolonged operative duration, hypertension, and preoperative urinary tract infection (UTI). The management strategy varied from conservative management with blood transfusion and antibiotics (n = 22, 55%) to percutaneous drainage (n = 11, 27.5%). Surgical intervention was needed in seven (17.5%) patients. Two of these were emergency angiography of which one proceeded to open nephrectomy. Open surgery with clot removal was done in three patients, nephrostomy for severe hydronephrosis in one patient, and surgery to correct malpositioned stent in one patient. There was one mortality reported, wherein a patient who had postangiography nephrectomy died of multiple organ failure after the intervention. CONCLUSION URS related PRH is a rare, but potentially life threatening complication with a small risk of renal loss. Although most cases may be managed conservatively, incidence of PRH can be minimized by control of blood pressure, treatment of preoperative UTI, and reduction in intrarenal pressures and operative time duration.
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Affiliation(s)
- Lily A Whitehurst
- 1 Department of Urology, Royal Hampshire County Hospital , Winchester, United Kingdom
| | - Bhaskar K Somani
- 2 Department of Urology, University Hospital Southampton NHS Foundation Trust , Southampton, United Kingdom
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20
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Kao MH, Wang CC. Risk factors for developing a perirenal hematoma after flexible ureteroscopic lithotripsy. UROLOGICAL SCIENCE 2016. [DOI: 10.1016/j.urols.2015.09.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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21
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Salvadó JA, Consigliere L, Gallegos H, Rojas F, Astroza G. Subcapsular Renal-Infected Hematoma After Retrograde Intrarenal Surgery: A Rare but Serious Complication. J Endourol Case Rep 2016; 2:52-4. [PMID: 27579416 PMCID: PMC4996627 DOI: 10.1089/cren.2016.0007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
We report a case of a 53-year-old woman affected by a left kidney stone and persistent positive urinary culture treated by retrograde intrarenal surgery. During postoperative day 1, she developed a sudden back pain associated with a decrease in hemoglobin. CT scan showed a subcapsular hematoma giving the impression of partial compression of kidney and upper urinary tract. For that reason, in the first instance, a Double-J ureteral stent was installed. Unfortunately, an open surgical drainage was necessary because a secondary infection of the hematoma was evident during the following days.
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Affiliation(s)
- José A Salvadó
- Departamento de Urología, Hospital Clínico Pontificia Universidad Católica de Chile , Santiago, Chile
| | - Lucas Consigliere
- Departamento de Urología, Hospital Clínico Pontificia Universidad Católica de Chile , Santiago, Chile
| | - Hector Gallegos
- Departamento de Urología, Hospital Clínico Pontificia Universidad Católica de Chile , Santiago, Chile
| | - Francisco Rojas
- Servicio de Urología, Hospital Dr. Sótero del Río , Puente Alto, Chile
| | - Gastón Astroza
- Departamento de Urología, Hospital Clínico Pontificia Universidad Católica de Chile , Santiago, Chile
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22
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Tao W, Cai CJ, Sun CY, Xue BX, Shan YX. Subcapsular renal hematoma after ureteroscopy with holmium:yttrium-aluminum-garnet laser lithotripsy. Lasers Med Sci 2015; 30:1527-32. [PMID: 25943289 DOI: 10.1007/s10103-015-1760-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Accepted: 04/23/2015] [Indexed: 11/29/2022]
Abstract
Subcapsular renal hematoma (SRH) after ureteroscopic lithotripsy (URSL) using holmium:yttrium-aluminum-garnet (Ho:YAG) laser to treat ureteric stones is a rare complication. We aimed to review our unit's experience of post-URSL subcapsular renal hematoma. From 2006 to 2012, 2059 URSLs using F9.5 rigid ureteroscope were performed in our unit. Patients with post-URSL symptomatic renal hematoma were reviewed. Perioperative information on patients' renal function, stone characteristics, and degree of renal hydronephrosis were reviewed. Operative data, postoperative information such as clinical manifestation, changes in blood parameters, CT findings, and subsequent treatment were documented. Of the 2059 patients treated with URSL and Ho:YAG laser, three patients were diagnosed as subcapsular renal hematoma after surgery; the age is 57, 61, and 63 years old, respectively. Preoperative imaging examination showed that two patients and one patient had obstructing middle and proximal ureteral stones ranging in size from 0.8 to 1.6 cm, and three patients had thin renal cortices. The double-J ureteral stents were inserted in all cases regularly. All three subcapsular renal hematoma patients had the loin pain of the operation side and fever, and one patient had significant hemoglobin drop (from 111 to 61 g/L) who need to transfusion. Two patients presented within 24 h of URSL, and one patient presented on day 10. One patient was treated conservatively for 3 weeks and recovered with bed rest, antibiotics, hemostasis, and analgesia with no intervention or drain. The other two patients underwent ultrasonography-guided drainage of the hematoma. Two-month follow-up CT scans or ultrasonography confirmed the resolution of the hematoma in all three cases. Renal subcapsular hematoma after URSL is a rare and one of serious complications. Subcapsular renal hematoma should be considered when patients have the symptoms of significant loin pain after URSL for obstructing ureteral stones with thin renal cortices. The treatment of post-URSL renal subcapsular hematomas needs to be customized for each patient.
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Affiliation(s)
- Wei Tao
- Department of Urology, The Second Affiliated Hospital of Soochow University, Suzhou, China,
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23
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Zhang P, Hu WL. Sudden onset of a huge subcapsular renal hematoma following minimally invasive ureteroscopic holmium laser lithotripsy: A case report. Exp Ther Med 2015; 10:335-337. [PMID: 26170958 DOI: 10.3892/etm.2015.2460] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Accepted: 04/02/2015] [Indexed: 11/06/2022] Open
Abstract
The postoperative complication rate of ureteroscopic lithotripsy (URSL) is low, and the most frequent complication is fever. Thus, urological surgeons often neglect or are unaware of subcapsular renal hematoma (SRH) as a rare complication following URSL. Although a SRH after undergoing URSL is uncommon, the occurrence may be fatal. The current study reports on a rare life-threatening case that occurred recently at Zhongnan Hospital (Wuhan, China). A 24-year-old male patient presented with a large SRH (11×14×11 cm) after undergoing a failed, but minimally invasive URSL with a holmium laser. The presence of the large SRH was confirmed by computerized tomography imaging. The patient underwent conservative management, which prevented hematoma enlargement, and no further treatment was conducted. In conclusion, SRH, although rare following URSL, should be noted by the urological surgeon.
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Affiliation(s)
- Peng Zhang
- Department of Urology, Zhongnan Hospital, Wuhan University, Wuhan, Hubei 430071, P.R. China
| | - Wan-Li Hu
- Department of Urology, Zhongnan Hospital, Wuhan University, Wuhan, Hubei 430071, P.R. China
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24
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Kozminski MA, Kozminski DJ, Roberts WW, Faerber GJ, Hollingsworth JM, Wolf JS. Symptomatic Subcapsular and Perinephric Hematoma Following Ureteroscopic Lithotripsy for Renal Calculi. J Endourol 2015; 29:277-82. [DOI: 10.1089/end.2014.0176] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Michael A. Kozminski
- Department of Urology, University of Michigan Medical School, Ann Arbor, Michigan
| | - David J. Kozminski
- Department of Urology, University of Michigan Medical School, Ann Arbor, Michigan
| | - William W. Roberts
- Department of Urology, University of Michigan Medical School, Ann Arbor, Michigan
| | - Gary J. Faerber
- Department of Urology, University of Michigan Medical School, Ann Arbor, Michigan
| | | | - J. Stuart Wolf
- Department of Urology, University of Michigan Medical School, Ann Arbor, Michigan
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25
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Zeng G, Zhu W, Li J, Zhao Z, Zeng T, Liu C, Liu Y, Yuan J, Wan SP. The comparison of minimally invasive percutaneous nephrolithotomy and retrograde intrarenal surgery for stones larger than 2 cm in patients with a solitary kidney: a matched-pair analysis. World J Urol 2014; 33:1159-64. [DOI: 10.1007/s00345-014-1420-4] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Accepted: 10/09/2014] [Indexed: 01/28/2023] Open
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26
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Schnabel MJ, Gierth M, Bründl J, Chaussy CG, Burger M, Fritsche HM. Antiplatelet and Anticoagulative Medication During Shockwave Lithotripsy. J Endourol 2014; 28:1034-9. [DOI: 10.1089/end.2014.0162] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Marco J. Schnabel
- Department of Urology, Caritas St. Josef Medical Center, University of Regensburg, Regensburg, Germany
| | - Michael Gierth
- Department of Urology, Caritas St. Josef Medical Center, University of Regensburg, Regensburg, Germany
| | - Johannes Bründl
- Department of Urology, Caritas St. Josef Medical Center, University of Regensburg, Regensburg, Germany
| | - Christian G. Chaussy
- Department of Urology, Caritas St. Josef Medical Center, University of Regensburg, Regensburg, Germany
| | - Maximilian Burger
- Department of Urology, Caritas St. Josef Medical Center, University of Regensburg, Regensburg, Germany
| | - Hans-Martin Fritsche
- Department of Urology, Caritas St. Josef Medical Center, University of Regensburg, Regensburg, Germany
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27
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Geavlete P, Multescu R, Geavlete B. Retrograde flexible ureteroscopic approach of upper urinary tract pathology: What is the status in 2014? Int J Urol 2014; 21:1076-84. [DOI: 10.1111/iju.12582] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Accepted: 06/22/2014] [Indexed: 11/30/2022]
Affiliation(s)
- Petrisor Geavlete
- Department of Urology; Saint John Emergency Clinical Hospital; Bucharest Romania
| | - Razvan Multescu
- Department of Urology; Saint John Emergency Clinical Hospital; Bucharest Romania
| | - Bogdan Geavlete
- Department of Urology; Saint John Emergency Clinical Hospital; Bucharest Romania
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28
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Rothberg MB, Monga M, Gupta M. Lumbar artery branch injury secondary to ureteroscopic manipulation. Can Urol Assoc J 2014; 8:E449-50. [PMID: 25024804 DOI: 10.5489/cuaj.1972] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Iatrogenic vascular injury in ureteroscopy is relatively uncommon and typically presents as a subcapsular hematoma. We report the case of an injury to a branch of the lumbar artery secondary to ureteral trauma during ureteroscopy. In the immediate postoperative period, the patient became hypotensive and tachycardic, prompting a workup that revealed an active hemorrhage. The patient then underwent subsequent angiogram and successful coil embolization.
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Affiliation(s)
| | - Manoj Monga
- Glickman Urological and Kidney Institute, The Cleveland Clinic, Cleveland, OH
| | - Mantu Gupta
- Columbia University Medical Center, New York, NY
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