Dadpour M. et al., 2025: Huge hematoma following extracorporeal shock wave lithotripsy leading to nephrectomy.

Mehdi Dadpour, Jamal Sadr, Seyed Mohammad Hashem Montazeri, Mina Vishteh, Sina Poorsalimi, Hamidreza Samadpour
Urol Case Rep. 2025 Aug 22;62:103164. doi: 10.1016/j.eucr.2025.103164 FREE FULL TEXT

Abstract

Extracorporeal shockwave lithotripsy (ESWL) is a noninvasive and relatively safe method for treating small urinary tract stones, however it may be accompanied with some important complications including hematoma. In this report, we review an instructive and rare case of a patient with massive renal hematoma following ESWL. Despite full conservative management, due to patient instability, emergent exploration and nephrectomy was inevitable. Massive hematoma leading to nephrectomy following ESWL procedure is very rare, but urologists should be aware. Also, if a patient is unstable and don't response to conservative treatment, nephrectomy may be considered after primary resuscitation.

Comment Hans-Göran Tiselius

This report describes a patient who developed hematoma after SWL. In this unusual case it was necessary to carry out nephrectomy because of the extensive bleeding. Usually when the bleeding is subcapsular it stops because of the surrounding pressure and the further course can be managed conservatively. In this case it seems as if the bleeding extended beyond the capsule and thus no natural compression occurred.
The only explanation of the huge bleeding is the patient’s history of hypertension. What “controlled hypertension” means in this case is not mentioned, but also in patients with a history of hypertensin is there an increased risk of bleeding and great care is needed to avoid renal trauma.

Hans-Göran Tiselius