Renal hematoma as a complication of extracorporeal shock wave lithotripsy

Objective: To evaluate risk factors, clinical presentation, therapeutic man agement, and treatment of residual stones and subsequent development of ren al hematoma following Extracorporeal Shock Wave Lithotripsy (ESWL). Materia l and methods: A retrospective review was made of 31 post-ESWL renal hemato ma cases diagnosed between May 1987 and June 1996. Lithotripsy treatments w ere outpatient procedures without anaesthesia. Our center has three electro magnetic sources, two with biplane X-ray centering and one ultrasound-guide d (SIEMENS Lithostar II(R), SIEMENS Lithostar System C(R) and SIEMENS Litho star Ultra(R), respectively). We analysed findings from patient history, ph ysical examination, blood analysis, and renovesical sonographs. Follow-up i nvolved periodical checks, blood analyses and removesical sonographs, sched uled first at three-month intervals and later at six-month intervals. Resul ts. Our center performed 21 699 lithotripsies on a total of 10 953 patients in this period. Thirty-one renal hematomas were diagnosed, giving an incid ence rate of 0.28%. Twenty-four patients presented clinical onsets and the commonest symptom for consultation was low back pain (74%). Eleven patients of this group (46%) were hypertensive. All patients received conservative treatment. With a mean follow-up time of 18 months, ultrasound showed persi stent hematoma in 11 patients (36%). There were residual stones in 71% of p atients; further lithotripsy was performed on seven patients with no clinic al or ultrasonographic signs of change in the hematoma. Conclusions: Renal hematoma post-ESWL is a rare complication. Main risk factors are hypertensi on, clotting disorders and previous ESWL sessions. Flank pain is the main s ymptom at presentation. Elective management is conservative. Presence of he matoma is not a contraindication for further treatments of residual stones.