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Year : 2000  |  Volume : 16  |  Issue : 2  |  Page : 154-156

An unusual complication after extra­corporeal shock wave lithotripsy for renal stone

Department of Urology, P.D. Hinduja National Hospital & Medical Research Centre, Mumbai, India

Correspondence Address:
S N Sagade
Department of Urology, P.D. Hinduja National Hospital and Medical Research Centre, V.S. Marg, Mahim, Mumbai - 400 016
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Source of Support: None, Conflict of Interest: None

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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

How to cite this URL:
Singh DR, Gaitonde K, Sagade S N. An unusual complication after extra­corporeal shock wave lithotripsy for renal stone. Indian J Urol [serial online] 2000 [cited 2023 Jan 28];16:154-6. Available from:

   Case Report Top

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 Top

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). [1] ESWL was first performed in 1980 for the treatment of urinary stones. [2] Post-lithotripsy complications are obstruction, infection, anuria, headache, cardiac arrest, renal failure and hae­matoma. [3] 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. [4] 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. [5] Stoller et al (1989) have reported 2 cases of severe renal haematoma after lithotripsy. [5] 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 Top

1.Krysiewcz S. Complications of renal extracorporeal shockwave lithotripsy reviewed. Urol Radiol 1992; 13:139-145.  Back to cited text no. 1    
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.  Back to cited text no. 2    
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.  Back to cited text no. 3    
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.  Back to cited text no. 4    
5.Stoller ML, Lawrence L, Salazar RG. Severe hemorrhage after ex­tracorporeal shockwave lithotripsy. Ann Int Med 1989; 11:612-613.  Back to cited text no. 5    


  [Figure 1], [Figure 2], [Figure 3]


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