Gupta R, 2011: Extracorporeal Shock Wave Lithotripsy-Induced Retroperitoneal Hemorrhage in a Case of Upper Ureteral Calculus With Angiomyolipoma
Gupta R, Dholaria P, Modi P, Rizvi J.
Department of Urology, Instituteof Kidney Diseases and ResearchCenter, Ahmedabad, Gujarat, India
Angiomyolipoma (AML) is considered as the most common cause of spontaneous renal hemorrhage.(1) However, the hemorrhage may be precipitated by the use of antiplatelet drugs, pregnancy, and trauma, or may occur spontaneously in a large size tumor. We present a case of isolated rightsided mid and upper pole AML associated with retroperitoneal bleeding following extracorporeal shock wave lithotripsy (SWL) for right upper ureteric stone. To the best of our knowledge, this is the first case of lithotripsy-induced retroperitoneal bleeding in a patient with AML, with no prior history of bleeding diasthesis or use of antiplatelet agents.
Urology Journal 2011; Vol 8; 72-4
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Urol J. 2011 Winter;8(1):72-4
PMID: 21404208 [PubMed - indexed for MEDLINE]
In this case report a patient with angiomyolipoma is presented in whom a retroperitoneal bleeding occurred as a complication to ESWL of a proximal ureteral stone. The kidney might have been hit by shockwaves as a result of respiratory movements during the treatment. Otherwise the image indicates that there is a reasonable distance between the uretral stone and the lower pole of the kidney.
The patient was obviously not on any kind of medication known to increase the risk of bleeding. Although the first ESWL-session apparently was uneventful it was after the repeated session that the bleeding complication occurred.
The lesson to be learnt from this case is that when there is a risk of subjecting the renal tissue to shockwave power, the presence of an angiomyolipoma constitutes a sign of warning. Moreover, also with normal kidney morphology it is wise to allow a longer period between two successive ESWL-sessions than 48h. It is not obvious from the report how much of the renal tissue that was in the shockwave field during the treatment.