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Pinto DS, Clode H, Madrazo BL, Paes FM, Alessandrino F. Imaging review of spontaneous renal hemorrhage. Emerg Radiol 2024; 31:515-528. [PMID: 38703272 DOI: 10.1007/s10140-024-02233-1] [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: 01/07/2024] [Accepted: 04/18/2024] [Indexed: 05/06/2024]
Abstract
Spontaneous renal hemorrhage (SRH) is a diagnostic challenge and a significant cause of morbidity, and sometimes mortality. Early identification is essential to institute lifesaving and reno-protective interventions. In this review, we classify spontaneous renal hemorrhage by location, presentation and etiology. We also discuss the diagnostic approach to renal hemorrhage and optimum imaging modalities to arrive at the diagnosis. Finally, we review strategies to avoid missing a diagnosis of SRH and discuss the pitfalls of imaging in the presence of renal hemorrhage.
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Affiliation(s)
- Denver S Pinto
- Jackson Memorial Hospital, University of Miami, Miami, USA.
| | - Hannah Clode
- Jackson Memorial Hospital, University of Miami, Miami, USA
- Department of Radiology, School of Medicine, University of Virginia, Charlottesville, VA, USA
| | | | - Fabio M Paes
- Miller School of Medicine, Jackson Memorial Hospital - Ryder Trauma Center, University of Miami, Miami, FL, USA
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2
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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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3
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Brevik A, Peta A, Okhunov Z, Afyouni AS, Bhatt R, Karani R, Xie L, Arada RB, Limfueco L, Sung JM, Jefferson FA, Parkhomenko E, Lama D, Safiullah S, Jiang P, Patel RM, Landman J. Prospective, Randomized Comparison of Dual Lumen Versus Single Lumen Flexible Ureteroscopes in Proximal Ureteral and Renal Stone Management. J Endourol 2022; 36:921-926. [PMID: 35262401 DOI: 10.1089/end.2022.0037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION We sought to compare the safety, efficacy, efficiency and surgeon experience during upper urinary tract stone management with single-lumen versus dual-lumen flexible ureteroscopes. MATERIALS AND METHODS Seventy-nine patients with proximal ureteral or renal stone burden < 2 cm were randomized to a single-lumen or dual-lumen flexible ureteroscopy. We recorded times for ureteroscopy, laser lithotripsy, stone basketing, as well as intraoperative and postoperative complications. The rate of stone clearance and stone free status were calculated using computed tomography imaging. Surgeons completed a survey after each procedure rating various metrics regarding ureteroscope performance. RESULTS Thirty-five patients from the single-lumen group and forty-four patients from the dual-lumen group had comparable median ureteroscopy time (37 vs 35 minutes, p=0.984) and basketing time (12 vs 19 min; p=0.584). Median lithotripsy time was decreased in the dual-lumen group (single: 6 vs dual: 2 min, p=0.017). The stone clearance rate was superior in the dual-lumen group (single: 3.7 vs dual: 7.1 mm3/min, p=0.025). The absolute stone-free rate was superior for the dual-lumen group (single: 26% vs dual: 48%, p=0.045). No differences in intraoperative (single: 0% vs dual: 2%; p=0.375) and postoperative complications (single: 7% vs dual: 11%, p=0.474) were observed. Surgeons' ratings of the dual-lumen ureteroscope was superior for visibility, comfort, ease of use, and overall performance. CONCLUSIONS The use of the dual-lumen ureteroscope in patients with renal and proximal ureteral stones < 2 cm provided shorter lithotripsy time, higher stone clearance rates, improved stone free rate and superior surgeon ratings when compared to single-lumen flexible ureteroscopes.
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Affiliation(s)
- Andrew Brevik
- University of California Irvine, 8788, Urology, 333 City Blvd. West, Suite 2100, Orange, California, United States, 92868.,UC Irvine Health, California, United States;
| | - Akhil Peta
- University of California Irvine, 8788, Urology, 333 City Blvd. West, Suite 2100, Irvine, California, United States, 92868;
| | - Zhamshid Okhunov
- University of California Irvine, 8788, Urology, Orange, California, United States;
| | - Andrew S Afyouni
- University of California Irvine, 8788, Urology, 29 Prairie Grass, Irvine, California, United States, 92603;
| | - Rohit Bhatt
- University of California Irvine, 8788, Urology, 20697 Hanford Drive, Cupertino, California, United States, 95014;
| | - Rajiv Karani
- University of California Irvine, 8788, Urology, 333 City Blvd W, Orange, California, United States, 92868;
| | - Lillian Xie
- University of California Irvine, 8788, Urology, Orange, California, United States;
| | - Raphael B Arada
- University of California Irvine Department of Urology, 481083, 101 The City Dr S, Orange, California, United States, 92868-2987;
| | - Luke Limfueco
- University of California Irvine School of Medicine, 12219, Urology, 333 City Blvd W Suite 2100, Orange, California, United States, 92868;
| | - John M Sung
- University of California Irvine School of Medicine, 12219, Urology, 333 City Blvd W, Orange, California, United States, 92868;
| | - Francis A Jefferson
- University of California Irvine School of Medicine, 12219, Urology, 333 City Blvd W, #2100, Orange, California, United States, 92697-3950;
| | - Egor Parkhomenko
- Boston University Medical Center, 1836, One boston medical place, Boston, Massachusetts, United States, 02118;
| | - Daniel Lama
- University of Cincinnati College of Medicine, 12303, Surgery, Division of Urology, 231 Albert Sabin Way ML 0589, Cincinnati, Cincinnati, Ohio, United States, 45267;
| | - Shoaib Safiullah
- University of Missouri Health Care, 4139, Surgery, 1 Hospital Drive, Columbia, Missouri, United States, 65212-0001.,University of California Irvine School of Medicine, 12219, Urology, 333 City Blvd W, Irvine, California, United States, 92697-3950;
| | - Pengbo Jiang
- University of California Irvine, 8788, Urology, Orange, California, United States;
| | - Roshan M Patel
- University of California Irvine, 8788, Urology, Orange, California, United States;
| | - Jaime Landman
- University of California Irvine, 8788, Urology, Orange, California, United States;
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Lin LC, Stone J, Singh S, Hsieh TC, Subramony R. Atraumatic Bilateral Renal Subcapsular Urinomas in a Young, Healthy Female. J Emerg Med 2022; 63:e82-e86. [PMID: 35279354 DOI: 10.1016/j.jemermed.2022.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Revised: 01/03/2022] [Accepted: 01/16/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Urinomas are rare and generally result from trauma to any part of the urinary collecting system. Appropriate imaging is crucial in the timely diagnosis and management of urinomas and for ruling out other etiologies such as subcapsular renal hematomas and perinephric abscesses. CASE REPORT A 31-year-old woman with no past medical history or known trauma presented to the Emergency Department (ED) with a week of right flank pain, abdominal pain, and intermittent fevers. On point-of-care ultrasound (POCUS), she was found to have a complex right perinephric collection, later confirmed with computed tomography (CT) imaging. She was treated with intravenous (IV) antibiotics and discharged after a 3-day hospital admission with instructions to follow up with Urology. A day later, she was readmitted with worsening bilateral flank pain and persistent fevers. Image-guided percutaneous aspirations of her bilateral perinephric fluid collections revealed both urine and blood. A right ureteral stent was then placed with ultimate resolution of her symptoms. Why Should an Emergency Physician Be Aware of This? Urinomas without history of trauma are rare and should be on the differential for patients presenting with flank pain and infectious symptoms. Urinomas or other expanding perinephric fluid collections can result in superimposed infection, rupture, secondary hypertension, and renal failure. Here, we present an atypical case of atraumatic bilateral renal subcapsular urinomas with hemorrhagic components in a young and healthy woman. Our case further outlines the utility of POCUS in the ED for the timely diagnosis and management of this disease process.
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Affiliation(s)
| | - Jennifer Stone
- Department of Emergency Medicine, University of California San Diego, San Diego, California
| | - Sukhdeep Singh
- Department of Emergency Medicine, University of California San Diego, San Diego, California
| | - Tung-Chin Hsieh
- Department of Urology, University of California San Diego, San Diego, California
| | - Rachna Subramony
- Department of Emergency Medicine, University of California San Diego, San Diego, California
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Nakamura H, Ko K, Kiseki H, Ikeda SI. Renal Subcapsular Hematoma Formation Due to Hydronephrosis Caused by Recurrent Uterine Cervical Cancer. J Med Cases 2021; 12:126-129. [PMID: 34434443 PMCID: PMC8383584 DOI: 10.14740/jmc3640] [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: 12/20/2020] [Accepted: 01/04/2021] [Indexed: 11/29/2022] Open
Abstract
Most non-traumatic renal subcapsular hematomas are found in the presence of primary or metastatic renal tumors, or in the presence of vascular disease of the renal blood vessels. We managed an asymptomatic renal subcapsular hematoma that formed due to uterine cervical cancer that metastasized to the left common iliac lymph nodes. A 48-year-old woman with stage IB1 cervical cancer underwent neoadjuvant chemotherapy and concurrent chemoradiation following a radical hysterectomy. Six months after the completion of her first treatment, she developed left-sided hydronephrosis, a left subcapsular hematoma and left common iliac lymph nodes enlargement as demonstrated with contrast-enhanced computed tomography. Although a renal subcapsular hematoma is rarely a symptom of cervical cancer recurrence, it should be considered if other neoplastic or vascular diseases are ruled out.
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Affiliation(s)
- Hana Nakamura
- Department of Obstetrics and Gynecology, Kohseichuo General Hospital, Tokyo, Japan.,Both authors contributed equally to this manuscript
| | - Kazuyoshi Ko
- Department of Urology, Kohseichuo General Hospital, Tokyo, Japan
| | - Hisami Kiseki
- Department of Obstetrics and Gynecology, Kohseichuo General Hospital, Tokyo, Japan
| | - Shun-Ichi Ikeda
- Department of Obstetrics and Gynecology, Kohseichuo General Hospital, Tokyo, Japan.,Both authors contributed equally to this manuscript
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Smith TA, Gage D, Quencer KB. Narrative review of vascular iatrogenic trauma and endovascular treatment. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:1199. [PMID: 34430640 PMCID: PMC8350708 DOI: 10.21037/atm-20-4332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 08/12/2020] [Indexed: 11/29/2022]
Abstract
Iatrogenic injury is unfortunately a leading cause of morbidity and mortality for patients worldwide. The etiology of iatrogenic injury is broad, and can be seen with both diagnostic and therapeutic interventions. While steps can be taken to reduce the occurrence of iatrogenic injury, it is often not completely avoidable. Once iatrogenic injury has occurred, prompt recognition and appropriate management can help reduce further harm. The objective of this narrative review it to help reader better understand the risk factors associated with, and treatment options for a broad range of potential iatrogenic injuries by presenting a series of iatrogenic injury cases. This review also discusses rates, risk factors, as well as imaging and clinical signs of iatrogenic injury with an emphasis on endovascular and minimally invasive treatments. While iatrogenic vascular injury once required surgical intervention, now minimally invasive endovascular treatment is a potential option for certain patients. Further research is needed to help identify patients that are at the highest risk for iatrogenic injury, allowing patients and providers to reconsider or avoid interventions where the risk of iatrogenic injury may outweigh the benefit. Further research is also needed to better define outcomes for patients with iatrogenic vascular injury treated with minimally invasive endovascular techniques verses conservative management or surgical intervention.
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Affiliation(s)
- Tyler Andrew Smith
- Department of Interventional Radiology, University of Utah, Salt Lake City, UT, USA
| | - David Gage
- Department of Medicine, Intermountain Healthcare, Murray, UT, USA
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Samet A, Mseddi MA, Kammoun O, Majdoub B, Rebai N, Hadjslimen M. Intrarenal foreign body after PCNL procedure: A rare complication. Urol Case Rep 2021; 35:101545. [PMID: 33391993 PMCID: PMC7772788 DOI: 10.1016/j.eucr.2020.101545] [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: 11/27/2020] [Revised: 12/15/2020] [Accepted: 12/17/2020] [Indexed: 11/28/2022] Open
Abstract
The use of LASER for lithotripsy has not only improved PCNL results, but also reported complications related to laser's use. We report a case of severed guide wire after PCNL.
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Affiliation(s)
- Ahmed Samet
- Urology Department, Academic Hospital Habib Bourguiba, Sfax, Tunisia
| | | | - Omar Kammoun
- Urology Department, Academic Hospital Habib Bourguiba, Sfax, Tunisia
| | - Brahim Majdoub
- Urology Department, Academic Hospital Habib Bourguiba, Sfax, Tunisia
| | - Nouri Rebai
- Urology Department, Academic Hospital Habib Bourguiba, Sfax, Tunisia
| | - Mourad Hadjslimen
- Urology Department, Academic Hospital Habib Bourguiba, Sfax, Tunisia
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