Tonolini M et al, 2015: Cross-sectional imaging of iatrogenic complications after extracorporeal and endourological treatment of urolithiasis.
Tonolini M, Villa F, Ippolito S, Pagani A, Bianco R
Department of Radiology, "Luigi Sacco" University Hospital, Via G.B. Grassi 74, 20157, Milan, Italy
Extracorporeal shock wave lithotripsy (ESWL), percutaneous nephrolithotomy (PCNL) and ureteroscopy (URS) currently represent the mainstay treatment options for the vast majority of patients with urolithiasis, with limited contraindications and high success rates. However, minimally invasive extracorporeal and endourological treatments are associated with a non-negligible morbidity including occasional life-threatening occurrences. These complications represent a source of concern for urologists since they may result in prolonged hospitalisation, need for surgical, endoscopic or interventional treatment, long-term renal impairment, and sometimes even medical malpractice claims. Due to the increasing prevalence of urolithiasis and the large number of therapeutic procedures performed, in hospitals with active urologic practices radiologists are increasingly requested to investigate suspected post-procedural complications following ESWL, PCNL or ureteroscopic stone removal. Based upon our experience, this pictorial essay provides an overview of current extracorporeal and endourological treatment modalities for urolithiasis, including indications and possible complications according to the most recent guidelines from the European Association of Urology (EAU). Afterwards, we review the clinical features and cross-sectional imaging appearances of common and unusual complications with case examples, including steinstrasse, subcapsular, perirenal and suburothelial haemorrhages, severe urinary tract infections (such as pyeloureteritis, pyelonephritis, renal abscesses and pyonephrosis), ureteral injuries and delayed strictures. Teaching points • Extracorporeal lithotripsy, percutaneous nephrolitotomy and ureteroscopy allow treating urolithiasis. • Minimally invasive extracorporeal and endourological treatment have non-negligible morbidity. • Multidetector CT allows confident assessment of stone-free status and postprocedural complications. • Main complications include steinstrasse, bleeding, severe infections, ureteral injuries and strictures. • Imaging triage allows the choice among conservative, surgical, endoscopic or interventive treatment.
Insights Imaging. 2014 Dec;5(6):677-89. doi: 10.1007/s13244-014-0355-z. Epub 2014 Sep 26. FREE ARTICLE
The article is an excellent review of complications associated with SWL, PNL and URS (RIRS). There are several examples illustrated mainly by CT-examinations. A detailed overview is provided of the range of complications that might be encountered as a result of stone removal. Reading this article is strongly recommended for educational purposes, not only for urologists, but also for all those, who see patients at the emergency unit, as well as for radiologists.
The important message is that complications do occur with all low- or non-invasive procedures for active stone removal and it is important to establish a correct diagnosis as early as possible.