Perirenal Hematoma After Ureteroscopy: A Systematic Review
Lily A Whitehurst1, Bhaskar K Somani2
11 Department of Urology, Royal Hampshire County Hospital , Winchester, United Kingdom .
Journal of Endourology
|December 22, 2016
Summary
Post-ureteroscopy (URS) perirenal hematoma (PRH) is a rare but serious complication. Minimizing PRH risk involves managing blood pressure, treating urinary tract infections, and reducing operative time during URS.
Area of Science:
- Urology
- Nephrology
Background:
- Ureteroscopy (URS) is increasingly used for complex stones and high-risk patients.
- This leads to a higher risk of serious complications, including perirenal hematoma (PRH).
Purpose of the Study:
- To define the incidence, predisposing factors, management, and long-term sequelae of post-URS perirenal hematoma (PRH).
Main Methods:
- A systematic literature review was conducted following Cochrane and PRISMA guidelines.
- Searched PubMed, EMBASE, CINAHL, and Cochrane Library for studies on post-URS PRH from 1980 to September 2016.
Main Results:
- Seven studies (8929 patients) reported a PRH incidence of 0.45%.
- Predisposing factors included hydronephrosis, thin renal cortex, prolonged operative duration, hypertension, and preoperative UTI.
- Management varied from conservative (55%) to percutaneous drainage (27.5%) and surgical intervention (17.5%), with one reported mortality.
Conclusions:
- Post-URS PRH is rare but potentially life-threatening, with a small risk of renal loss.
- Most cases can be managed conservatively.
- Minimizing PRH incidence requires controlling blood pressure, treating UTIs, and reducing operative time and intrarenal pressures.
