title: Renal subcapsular hemorrhage complicating ureterolithotripsy: an unknown complication of a known day-to-day procedure.
abstract: OBJECTIVE
  To report the incidence, risk factors, and treatments of renal subcapsular hemorrhage (RSH) complicating ureteroscopic lithotripsy (URSL).
  
  
  METHODS
  Data from 1,918 URSLs performed between January 2004 and March 2012 were retrospectively analyzed. Patients' data included age, sex, relevant medical history, stone side, size, and degree of hydronephrosis.
  
  
  RESULTS
  All 8 patients were identified as having an RSH after URSL. There were 2 males and 6 females with a mean age of 45.6 years (range 30-62 years). The patients' relevant medical histories (renal calculi extracorporeal shock wave lithotripsy, renal operation and hypertension) were statistically different between those who did and did not develop an RSH. Acute onset of flank pain is the most common symptom. Three patients with infective and large hemorrhage were managed by percutaneous nephrostomy in 1 and percutaneous subcapsular drainage in 2. Five patients with small and uninfected hemorrhage were managed conservatively.
  
  
  CONCLUSIONS
  The rate of development of RSH complicating URSL is very low. RSH complicating URSL can occur in patients with underlying renal abnormalities. RSH is rarely associated with abrupt hemodynamic instability and usually not lethal. Treatment is selected based on the patient's hemodynamic state, infection, renal function, and the feasibility of treatment modality.
authors.affiliation: Department of Urology, The First Affiliated Hospital of Medical College, Zhejiang University, Hangzhou, China.
authors.forename: Hongzhou
authors.initials: H
authors.lastname: Meng
authors.forename: Shanwen
authors.initials: S
authors.lastname: Chen
authors.forename: Geming
authors.initials: G
authors.lastname: Chen
authors.forename: Fuqing
authors.initials: F
authors.lastname: Tan
authors.forename: Chaojun
authors.initials: C
authors.lastname: Wang
authors.forename: Baihua
authors.initials: B
authors.lastname: Shen
mesh_terms: D000328:Adult; D003287:Contrast Media; D004724:Endoscopy; D005260:Female; D006439:Hemodynamics; D006470:Hemorrhage / Q000453:epidemiology / Q000209:etiology*; D006801:Humans; D006869:Hydronephrosis / Q000601:surgery; D006973:Hypertension / Q000150:complications; D015994:Incidence; D007668:Kidney / Q000098:blood supply* / Q000601:surgery; D007669:Kidney Calculi / Q000601:surgery; D007834:Lasers; D008096:Lithotripsy; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014514:Ureteral Calculi / Q000601:surgery* / Q000628:therapy*; D018666:Ureteroscopy / Q000009:adverse effects*
chemical_list: D003287:Contrast Media