Kidney changes after extracorporeal shock wave lithotripsy: CT evaluation

Computed tomography (CT) was performed in 50 patients before and after extracorporeal shock wave lithotripsy (ESWL) to determine the effects of ESWL on the kidney and perinephric tissues. Bilateral treatments were performed in three patients. Post-ESWL scans demonstrated subcapsular hematomas in eight (15%) patients (two large, six small, none symptomatic) and intrarenal hematomas in two (4%) patients. In three (6%) patients small subcapsular fluid collections of uncertain cause were seen. Treated kidneys showed a statistically significant mean increase in size (9%) after ESWL, as measured at the axial level of the major stone fragment. Perinephric soft-tissue stranding and fascial thickening were seen in 37 (70%) of 53 treated renal fossae, with the changes ranging from mild to severe. The authors conclude that while most patients undergoing ESWL will show some posttreatment abnormality on CT scans, the procedure appears to be associated with a low frequency of serious renal trauma.