Stone fragments migration into subcapsular renal hematoma post flexible ureterorenoscopy (unique presentation)

Superselective renal arterial embolization in treatment for severe renal hemorrhage after flexible ureterorenoscopy and laser lithotripsy (FURSL)

OBJECTIVE

Life-threatening renal hemorrhage after flexible ureterorenoscopy and laser lithotripsy (FURSL) is a rare complication. We aim to review our unit's experience with super-selective renal artery embolization as therapeutic options for such patients.

METHODS

From January 2015 to November 2021, total 1125 patients underwent the FURSL procedures in our unit. Patients with life-threatening renal hemorrhage were reviewed and the information of peri-operative, operative and post-operative were recorded.

RESULTS

Of the 1125 patients who underwent FURSL procedure, two patients with life-threatening renal hemorrhage were diagnosis; the age is 67 and 42 years old, respectively. Preoperative imaging examination showed that two patients had upper ureteral stone and renal stone ranging in size from 1.2 to 3.0 cm. Female patient placed the D-J stent for two weeks before FURSL. After the operation, both patients had the massive gross hematuria, significant drop of hemoglobin (Hgb), blood pressure lowering and needed to transfusion. CT scan showed that the male patient had an intrarenal hematoma. All these two were treated by super-selective renal artery embolization and had a successful outcome.

CONCLUSION

Life-threatening renal hemorrhage after FURSL is a rare and severe complication. Super-selective renal artery embolization is a safe and effective method for the treatment of patients with severe renal hemorrhage, preserving healthy renal parenchyma and renal function.