|Year : 2000 | Volume
| Issue : 2 | Page : 154-156
An unusual complication after extracorporeal shock wave lithotripsy for renal stone
Dharm Raj Singh, Krishnanath Gaitonde, SN Sagade
Department of Urology, P.D. Hinduja National Hospital & Medical Research Centre, Mumbai, India
S N Sagade
Department of Urology, P.D. Hinduja National Hospital and Medical Research Centre, V.S. Marg, Mahim, Mumbai - 400 016
Source of Support: None, Conflict of Interest: None
Keywords: Renal Stones; Lithotripsy.
|How to cite this article:|
Singh DR, Gaitonde K, Sagade S N. An unusual complication after extracorporeal shock wave lithotripsy for renal stone. Indian J Urol 2000;16:154-6
| Case Report|| |
A 42-year-old male patient who was a known case of bilateral renal stones and right upper ureteric stones [Figure 1] underwent right ureterolithotomy and right DJ (Double J) stent insertion. There was incomplete clearance of right ureteric stones. A few weeks later he underwent left DJ stenting and Extracorporeal Shockwave Lithotripsy (ESWL) for left renal stone. On 10th post-lithotripsy day, he presented in our emergency department with left flank pain, fever and vomiting since 2 days. On physical examination temperature was 100.8° F, pulse was 118/min and blood pressure was 200/110 mg/mm Hg. Abdominal examination revealed tender lump in left lumbar and iliac fossa region along with fullness of the renal angle.
On investigation his haemoglobin and total leukocyte count were 10.7 gm/dl and 16.000/mm . The serum creatinine was 4.1 mg/dl. Plain x-ray of the kidney, ureter and bladder (KUB) showed bilateral DJ stents along with residual right upper ureteric stone and no stones in left renal areas [Figure 2]. Plain computed tomography (CT) scan of the abdomen demonstrated about 12+10 cm size haematoma around the left kidney and psoas muscle. There was loss of corticomedullary differentiation of the kidney [Figure 3]. Bilateral DJ stents and right atrophic kidney were also seen in the CT Scan. Patient was subjected for emergency surgery. Via 11th rib flank incision drainage of perinephric and subcapsular haematoma was performed. The left DJ stent was removed. Postoperative period was uneventful. His serum creatinine value came down and was 1.7 mg/dl on 10th postoperative day.
| Comments|| |
Extracorporeal shockwave lithotripsy is an effective and non-invasive method for the treatment of a variety of urinary calculi with less morbidity than open surgery and percutaneous nephrolithotomy (PCNL).  ESWL was first performed in 1980 for the treatment of urinary stones.  Post-lithotripsy complications are obstruction, infection, anuria, headache, cardiac arrest, renal failure and haematoma.  Ueda et al reported 4.1% incidence of subcapsular haematoma in a series of 402 patients treated ESWL of which about half showed associated fractures of the kidney on CT scan evaluation.  In the same series pretreatment hypertension (>160/95 mm Hg) and use of antiplatelet agents were associated with higher incidence of haematoma after ESWL. Early onset and persistence of severe haematuria and large number of high voltage shock waves are other risk factors for internal bleeding.  Stoller et al (1989) have reported 2 cases of severe renal haematoma after lithotripsy.  One patient died due to inability to diagnose it by ultrasonography while other patient survived after immediate start of resuscitative measures. In present case, ESWL resulted in huge subcapsular and perinephric haematoma along with extensive destruction of the parenchyma. Patient presented to us in septicaemia. Early surgical intervention (in the form of open drainage), broad spectrum antibiotics along with other supportive measures resulted in renal salvage.
| References|| |
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|2.||Chaussy C, Schmiedt E, Jocham D et al. First clinical experiece with extracorporeally induced destruction of kidney stones by shock waves. J Urol 1982; 127:417-420. |
|3.||Sofras F, Karayannis A, Kostakopoulos A et al. Methodology, Results and Complications in 2000 extracorporeal shock wave lithotripsy procedures. BJ Urol 1988; 61:9-13. |
|4.||Ueda S, Matsuoka K, Yamashita T et al. Perirenal hematomas caused by SWL with EDAP LT-01 Lithotripter. J Endourol 1993; 7:11-15. |
|5.||Stoller ML, Lawrence L, Salazar RG. Severe hemorrhage after extracorporeal shockwave lithotripsy. Ann Int Med 1989; 11:612-613. |
[Figure 1], [Figure 2], [Figure 3]