Subcapsular hematoma after ureteroscopy and laser lithotripsy

Area of Science:

• Urology
• Nephrology
• Surgical Complications

Background:

• Subcapsular renal hematoma is a rare complication following ureteroscopic lithotripsy (URSL).
• Holmium:yttrium-aluminum-garnet (Ho:YAG) laser is commonly used for URSL.

Purpose of the Study:

• To review the center's experience with post-URSL subcapsular hematoma.
• To identify risk factors and management strategies for this rare complication.

Main Methods:

• Retrospective review of 1114 URSL procedures performed between 2007 and 2012.
• Analysis of perioperative data, clinical presentation, laboratory findings, imaging, and management of patients diagnosed with symptomatic renal hematoma.

Main Results:

• Four cases (0.36%) of post-URSL subcapsular hematoma were identified.
• Patients presented with loin pain, fever, and hemoglobin drop, often associated with proximal ureteral stones and thin renal cortices.
• Management varied from conservative treatment to drainage or emergency surgery, with complete resolution in all cases.

Conclusions:

• Post-URSL subcapsular hematoma, though rare, requires a high index of suspicion.
• Prompt diagnosis and individualized management are essential for favorable outcomes.
• Patients with obstructing proximal ureteral stones and thin renal cortices may be at higher risk.