ORIGINAL ARTICLE   

Minerva Urologica e Nefrologica 2018 December;70(6):617-23

DOI: 10.23736/S0393-2249.18.03199-5

Copyright © 2018 EDIZIONI MINERVA MEDICA

language: English

Subcapsular renal hematoma after retrograde ureterorenoscopic lithotripsy: our experience

Davide CAMPOBASSO ¹ ✉, Marco GRANDE ¹, Stefania FERRETTI ², Matteo MORETTI ¹, Francesco FACCHINI ¹, Michelangelo LAROSA ¹, Paolo SALSI ², Pietro GRANELLI ², Gian Luigi POZZOLI ¹, Antonio FRATTINI ¹

¹ Unit of Urology, Civil Hospital of Guastalla, AUSL Reggio Emilia, Reggio Emilia, Italy; ² Service of Endourology and Mini-invasive Percutaneous Surgery, Unit of Urology, Parma University Hospital, Parma, Italy

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.

KEY WORDS: Hematoma - Ureteroscopy - Complications