輸尿管鏡下段泌尿道結石氣動碎石手術後腎臟包膜下血腫
李日馳、黃馨葦、陳忠賢、王華斌、盧嘉文、江朝洋、林鴻裕、黃景榆、陳毓騏、余燦榮、林嘉祥
義大醫院醫院 泌尿科; 義守大學
Subcapsular renal hematoma after ureteroscopic pneumatic lithotripsy for Lower ureter stone
Ryh-Chyr Lee, Hsin-Wei Huang, Chung-Hsien Chen, Hua-Pin Wang, Kevin Lu, Chao-Yang Jiang, Tsan- Jung Yu, Victor C. Lin
Division of Urology, Department of Surgery, E-Da Hospital, I-Shou University, Kaohsiung city, Taiwan
Introduction:
Ureteroscopy is widely used in treating upper urinary tract pathologies. Ureteroscopic lithotripsy (URSL) has been a common management for urolithiasis. Complications of ureteroscopic procedures are often mild and need only conservative treatment, while there are still some severe and fatal complications. Renal subcapsular hematoma is not an uncommon complication after extracorporeal shock wave lithotripsy, trauma, renal angiographic procedures and spontaneously in patients of malignancy and in patients on anticoagulation. But only few cases of subcapsular hematoma after ureteroscopy has been mentioned in literature.
Abstract:
In this article, we presented a rare case of SRH after URSL with lithocast. This 55 year-old female patient visited urology clinic due to persisted left flank pain after URSL 1 month ago. Serial image study revealed residual left lower ureter stone with hydronephrosis. Repeated left ureteroscopic stone manipulation with lithoclast was arranged then. However, she returned to emergent department due to severe left flank pain and reduced hemoglobin level. Computed tomography showed a 12*6.6*1.5cm hematoma over subcapsular space of left kidney.
Clinical spectrum of subcapsular hematoma following ureteroscopy varies and management options depend upon the severity of hematoma. We discussed the possible risk factors, causative mechanism and management of this patient and also reviewed literatures concerning incidence, proposed mechanism, prevention and management of subcapsular hematoma following ureteroscopic procedures.