Collado Serra A, Huguet Pérez J, Monreal García de Vicuña F, Rousaud Barón A, Izquierdo de la Torre F, Vicente Rodríguez J
Radiology Service, Barcelona, Spain.
Scand J Urol Nephrol. 1999 Jun;33(3):171-5. doi: 10.1080/003655999750015943.
To evaluate risk factors, clinical presentation, therapeutic management, and treatment of residual stones and subsequent development of renal hematoma following Extracorporeal Shock Wave Lithotripsy (ESWL).
A retrospective review was made of 31 post-ESWL renal hematoma cases diagnosed between May 1987 and June 1996. Lithotripsy treatments were outpatient procedures without anaesthesia. Our center has three electromagnetic sources, two with biplane X-ray centering and one ultrasound-guided (SIEMENS Lithostar II, SIEMENS Lithostar System C and SIEMENS Lithostar Ultra, respectively). We analysed findings from patient history, physical examination, blood analysis, and renovesical sonographs. Follow-up involved periodical checks, blood analyses and renovesical sonographs, scheduled first at three-month intervals and later at six-month intervals.
Our center performed 21 699 lithotripsies on a total of 10 953 patients in this period. Thirty-one renal hematomas were diagnosed, giving an incidence 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 persistent hematoma in 11 patients (36%). There were residual stones in 71% of patients; further lithotripsy was performed on seven patients with no clinical or ultrasonographic signs of change in the hematoma.
Renal hematoma post-ESWL is a rare complication. Main risk factors are hypertension, clotting disorders and previous ESWL sessions. Flank pain is the main symptom at presentation. Elective management is conservative. Presence of hematoma is not a contraindication for further treatments of residual stones.
评估体外冲击波碎石术（ESWL）后残余结石的危险因素、临床表现、治疗管理以及肾血肿的发生和后续发展情况。
对1987年5月至1996年6月期间诊断出的31例ESWL后肾血肿病例进行回顾性分析。碎石治疗为门诊手术，无需麻醉。我们中心有三个电磁源，两个配备双平面X射线定位，一个为超声引导（分别为西门子Lithostar II、西门子Lithostar系统C和西门子Lithostar Ultra）。我们分析了患者病史、体格检查、血液分析和肾膀胱超声检查的结果。随访包括定期检查、血液分析和肾膀胱超声检查，最初每三个月进行一次，之后每六个月进行一次。
在此期间，我们中心共对10953例患者进行了21699次碎石治疗。诊断出31例肾血肿，发病率为0.28%。24例患者出现临床症状，最常见的就诊症状是腰痛（74%）。该组中有11例患者（46%）患有高血压。所有患者均接受保守治疗。平均随访时间为18个月，超声检查显示11例患者（36%）存在持续性血肿。71%的患者有残余结石；对7例血肿无临床或超声变化迹象的患者进行了进一步的碎石治疗。
ESWL后肾血肿是一种罕见的并发症。主要危险因素是高血压、凝血障碍和既往ESWL治疗史。胁腹痛是主要的就诊症状。选择性治疗为保守治疗。存在血肿并非进一步治疗残余结石的禁忌证。
