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Kim GH et al, 2013: Acute cyst rupture, hemorrhage and septic shock after a shockwave lithotripsy in a patient with autosomal dominant polycystic kidney disease

Kim HG, Bae SR, Lho YS, Park HK, Paick SH.
Department of Urology, Konkuk University School of Medicine, 4-12 Hwayang-Dong, Gwangjin-Ku, Seoul, 143-729, Korea


Abstract

The incidence of urinary calculi in autosomal dominant polycystic kidney disease (ADPKD) ranges from 10 to 36 %. Shockwave lithotripsy (SWL) for urinary calculi in ADPKD was reported to be a safe and effective treatment option. However, there is a potential risk of cyst rupture and traumatic hemorrhage because of shockwaves. A 39-year-old female with polycystic kidneys and upper ureter stone was treated with SWL and developed life-threatening complications of cyst rupture, traumatic hemorrhage and septic shock. She was initially treated with supportive care in the intensive care unit, but in the end nephrectomy was performed.

Urolithiasis. 2013 Mar 3. [Epub ahead of print]
PMID:23456211 [PubMed - as supplied by publisher]

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Comments 1

Hans-Göran Tiselius on Monday, 31 December 2012 06:44

This case report describes a very unusual complication associated with SWL of a proximal ureteral stone. Unfortunately no details are given on the condition of the patient at the time of SWL. Was there a history of infection or bacteriuria? Had there been any pre-SWL ureteral manipulation and how extensive had the lithotripsy been? It is surprising that the cyst in which the bleeding obviously originated is located so far from the expected SWL focus.

The authors' conclusion that there is a risk of complications following treatment of proximal ureteral stones in ADPKD patients possibly should be expanded to SWL of stones at all locations in such kidneys. Moreover, it seems advisable to pre-treat these patients with antibiotics and if the obstruction is pronounced always to decompress the collecting system before SWL.

Hans-Göran Tiselius

This case report describes a very unusual complication associated with SWL of a proximal ureteral stone. Unfortunately no details are given on the condition of the patient at the time of SWL. Was there a history of infection or bacteriuria? Had there been any pre-SWL ureteral manipulation and how extensive had the lithotripsy been? It is surprising that the cyst in which the bleeding obviously originated is located so far from the expected SWL focus. The authors' conclusion that there is a risk of complications following treatment of proximal ureteral stones in ADPKD patients possibly should be expanded to SWL of stones at all locations in such kidneys. Moreover, it seems advisable to pre-treat these patients with antibiotics and if the obstruction is pronounced always to decompress the collecting system before SWL. Hans-Göran Tiselius
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