SWL literature
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Reviewer's Choice 

Hallmann S et al, 2017: Successful evacuation of large perirenal hematoma after extracorporeal shock wave lithotripsy (ESWL) - step 1 of the IDEAL recommendations of surgical innovation.

Hallmann S, Petersein J, Ruttloff J, Ecke TH.
Department of Urology HELIOS Hospital Bad Saarow Germany.
Institute of Radiology HELIOS Hospital Bad Saarow Germany.

 Abstract

Larger perirenal hematomas after extracorporeal shock wave lithotripsy (ESWL) are sometimes related to the loss of renal function due to compression of the normal renal tissue. After computed tomography-guided drainage and locally applied urokinase, the hematoma was fractionally evacuated. This procedure is a save and fast way to recover normal renal function.

Clin Case Rep. 2017 Jan 16;5(2):123-125. doi: 10.1002/ccr3.792.

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Comments 1

Hans-Göran Tiselius on Friday, 14 July 2017 08:22

Active treatment of SWL-associated hematomas is seldom reported in the literature and the vast majority of such patients are certainly treated conservatively. The risk of developing Page-kidney with chronically reduce renal function probably should be considered more often.

The authors describe a procedure in which dissolution of coagulated blood with urokinase is combined with suction twice daily. A major concern is that treatment with urokinase might result in maintained bleeding. Another aspect is the risk of infection associated with the intervention and it is not mentioned in the report if any antibiotics were administered during the 14-day period required for the procedure. For this kind of treatment correct timing seems to be of crucial importance.

In this specific patient it cannot be excluded that the obstruction was caused by ureteral compression from the hematoma and that stenting had been an acceptable and less invasive approach.

Nevertheless this report describes an interesting low-invasive approach when it is likely that compression of a large hematoma might jeopardize renal function. For these patients a low-invasive method seems as an alternative that definitely is superior open surgery.

Active treatment of SWL-associated hematomas is seldom reported in the literature and the vast majority of such patients are certainly treated conservatively. The risk of developing Page-kidney with chronically reduce renal function probably should be considered more often. The authors describe a procedure in which dissolution of coagulated blood with urokinase is combined with suction twice daily. A major concern is that treatment with urokinase might result in maintained bleeding. Another aspect is the risk of infection associated with the intervention and it is not mentioned in the report if any antibiotics were administered during the 14-day period required for the procedure. For this kind of treatment correct timing seems to be of crucial importance. In this specific patient it cannot be excluded that the obstruction was caused by ureteral compression from the hematoma and that stenting had been an acceptable and less invasive approach. Nevertheless this report describes an interesting low-invasive approach when it is likely that compression of a large hematoma might jeopardize renal function. For these patients a low-invasive method seems as an alternative that definitely is superior open surgery.
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