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Extracorporeal shock wave lithotripsy-induced perirenal hematomas
P M Knapp1, T B Kulb, J E Lingeman
1Methodist Hospital Institute for Kidney Stone Disease, Indianapolis, Indiana.
The Journal of Urology
|April 1, 1988
Summary
Extracorporeal shock wave lithotripsy (ESWL) can cause bleeding, with hypertension being a significant risk factor. Uncontrolled hypertension increases the risk of post-ESWL hematomas, necessitating careful patient selection and management.
Area of Science:
- Urology
- Nephrology
- Medical Engineering
Background:
- Subcapsular or perirenal bleeding is a known adverse effect of extracorporeal shock wave lithotripsy (ESWL).
- Understanding risk factors for post-ESWL hematoma is crucial for patient safety.
Purpose of the Study:
- To investigate the incidence of perinephric hematomas following ESWL.
- To identify patient and treatment-related factors associated with hematoma development.
Main Methods:
- Retrospective analysis of 3,620 ESWL treatments using the HM3 Dornier lithotriptor.
- Examination of factors including shock wave parameters, patient demographics, stone characteristics, and pre-existing conditions.
Main Results:
- An overall hematoma incidence of 0.66% was observed.
- Pre-existing hypertension, especially when uncontrolled (3.8% incidence), significantly increased hematoma risk.
- Increased incidence also noted with pre-treatment urinary tract infection and simultaneous bilateral ESWL.
Conclusions:
- Pre-existing hypertension is a significant risk factor for post-ESWL perinephric hematoma.
- Careful consideration of hypertension control and other risk factors is recommended prior to ESWL.
- Conservative management is typical for post-ESWL bleeding, though transfusions may be required.