Telegrafo M et al, 2016: Diagnostic and prognostic role of computed tomography in extracorporeal shock wave lithotripsy complications.
Telegrafo M, Carluccio DA, Rella L, Ianora AA, Angelelli G, Moschetta M.
Department of Interdisciplinary Medicine, Section of Diagnostic Imaging, Aldo Moro University of Bari Medical School, Piazza Giulio Cesare 11, 70124 Bari, Italy.
PURPOSE: To evaluate the role of multidetector computed tomography (MDCT) in recognizing the complications of extracorporeal shock wave lithotripsy (ESWL) and providing a prognostic grading system for the therapeutic approach.
MATERIALS AND METHODS: A total of 43 patients who underwent ESWL because of urinary stone disease were assessed by 320-row MDCT examination before and after ESWL. Pre-ESWL CT unenhanced scans were performed for diagnosing stone disease. Post-ESWL CT scans were acquired before and after intravenous injection of contrast medium searching for peri-renal fluid collection or hyper-density, pyelic or ureteral wall thickening, blood clots in the urinary tract, peri- or intra-renal hematoma or abscess, active bleeding. A severity grading system of ESWL complications was established.
RESULTS: Patients were affected by renal (n = 36) or ureteral (n = 7) lithiasis. Post-ESWL CT examination detected small fluid collections and hyper-density of peri-renal fat tissue in 35/43 patients (81%), pyelic or ureteral wall thickening in 2/43 (4%), blood clots in the urinary tract in 9/43 (21%), renal abscesses or hematomas with a diameter of <2 cm in 10/43 (23%), large retroperitoneal collections in 3/43 (7%), active bleeding from renal vessels in 1/43 (2%). Mild complications were found in 30 cases; moderate in 9; severe in 4. The therapeutic choice was represented by clinical follow-up (n = 20), clinical and CT follow-up (n = 10), ureteral stenting (n = 9), drainage of large retroperitoneal collections (n = 3), and arterial embolization (n = 1).
CONCLUSION: MDCT plays a crucial role in the diagnosis of urolithiasis and follow-up of patients treated with ESWL recognizing its complications and providing therapeutic and prognostic indications.
Urol Ann. 2016 Apr-Jun;8(2):168-72. doi: 10.4103/0974-7796.163792.
6 Radiologists and no Urologist present data on 43 of 120 patients who were treated by ESWL and had CTs because of postprocedural symptoms of acute or persistent flank pain (35), macro-hematuria (11), sepsis (13) or severe anaemia (1) or ultrasound examinations showing perirenal fluid collections (22), parenchymal changes (16) or pyelectasis( 8). There is no information on the treatment parameters. 13 cases of sepsis, 3 cases of drainage of large retroperitoneal fluid collections and 1 arterial embolization are very unusual.