title: Renal hematoma as a complication of extracorporeal shock wave lithotripsy.
abstract: OBJECTIVE
  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).
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Radiology Service, Barcelona, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Collado Serra
authors.forename: J
authors.initials: J
authors.lastname: Huguet Pérez
authors.forename: F
authors.initials: F
authors.lastname: Monreal García de Vicuña
authors.forename: A
authors.initials: A
authors.lastname: Rousaud Barón
authors.forename: F
authors.initials: F
authors.lastname: Izquierdo de la Torre
authors.forename: J
authors.initials: J
authors.lastname: Vicente Rodríguez
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006406:Hematoma / Q000175:diagnosis / Q000209:etiology*; D006801:Humans; D007668:Kidney / Q000000981:diagnostic imaging; D007669:Kidney Calculi / Q000150:complications / Q000628:therapy; D007674:Kidney Diseases / Q000175:diagnosis / Q000209:etiology*; D008096:Lithotripsy / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography