Sermeus L et al, 2017: Hypovolemic Shock Caused by Massive Renal Hematoma After a Third Consecutive Extracorporeal Shockwave Lithotripsy Session: A Case Report.
Sermeus L, Vander Eeckt K, Ost D, Van Den Branden M.
Faculty of Medicine, Katholieke Universiteit Leuven , Leuven, Belgium.
AZ Sint Blasius , Dendermonde, Belgium.
Extracorporeal shockwave lithotripsy (SWL) is a commonly used technique for treating urinary calculi. Although noninvasive, highly effective, and widely accepted, SWL is not without complications. Next to fragmenting the calculi, the surrounding tissue is damaged, which can result in renal hematoma, a well-described complication. In most cases, the collateral tissue damage is mild and resolves with conservative treatment. However, rarely, severe complications may arise. Here we present a case of a 46-year-old male who developed a massive hematoma, both subcapsular and retroperitoneal, after a third consecutive SWL session, resulting in hypovolemic shock. Different probable causes are proposed, of which one cause, the length of the interval between SWL sessions, is not yet studied properly. Probably, short intervals keep the damaged tissue from healing sufficiently, as proposed in our case. Possibly, life-threatening situations can be avoided if more evidence-based guidelines are available.
J Endourol Case Rep. 2016 Dec 1;2(1):243-245. doi: 10.1089/cren.2016.0127. FREE ARTICLE
The patient was initially admitted to the emergency room because of colicky pain and hydronephrosis due to an obstructing stone in the UP junction. A blood pressure of 200/130 mm Hg was reported which is a contraindication to do ESWL. No subsequent measurements of the blood pressure or medication to lower the blood pressure are reported and it is also not mentioned if the hydronephrosis persisted which also would have added to a risk of kidney damage. “Three successive SWL sessions were performed in 16 days, with the first and second interval being 2 and 14 days, respectively.” Concerning the interval between ESWL sessions the EAU guidelines are quoted properly with a grade 4 recommendation: “There are no conclusive data on the intervals required between repeated ESWL sessions. However, clinical experience indicates that repeat sessions are feasible (within 1 day for ureteral stones)”.
For those interested in this topic I recommend reading two publications which have been reviewed previously: Hughes S. et al. A Pilot Study to Evaluate Haemostatic Function, following Shock Wave Lithotripsy (SWL) for the Treatment of Solitary Kidney Stones (PLOS ONE | DOI:10.1371/2015) and Lee FC et al6 2015: Renal Vasoconstriction Occurs Early During Shockwave Lithotripsy in Humans (J Endourol. 2015 Dec;29(12):1392-5). Both articles can be accessed free on PubMed.