title: Capsulotomy for treatment of compartment syndrome in patients with post extracorporeal shock wave lithotripsy renal hematomas: safe and effective, but also advisable?
abstract: OBJECTIVE
  To examine whether surgical decompression of hematomas by capsulotomy can help to improve long-term renal function following extracorporeal shock wave lithotripsy (SWL).
  
  
  METHODS
  This study retrospectively identified 7 patients who underwent capsulotomy for post SWL renal hematomas between 2008 and 2012. The control group comprised 8 conservatively treated patients. The median follow-up time was 22 months.
  
  
  RESULTS
  The two groups were comparable in age, gender, body mass index, risk factors for developing hematomas (renal failure, urinary flow impairment, indwelling ureteral stent and diabetes mellitus) and the selected SWL modalities. Hematoma size was also similar. However, significantly more patients in the surgical group had purely intracapsular hematomas (85.7% vs. 37.5%) without a potentially pressure-relieving capsular rupture. There were no significant differences in the post-interventional drop in hemoglobin, rise in retention parameters or drop in glomerular filtration rate (GFR). No capsulotomy-related complications were observed, but surgery required a significantly longer hospital stay than conservative management (median, 9 days vs. 5 days). The two groups also showed comparable recovery of renal function at long-term follow-up (median change in GFR from baseline, 97.1% and 97.8%, respectively).
  
  
  CONCLUSIONS
  Since renal function did not differ between the two treatment groups, the conservative management remains the standard treatment for post-SWL renal hematoma.
authors.affiliation: Department of Urology, Ulm University Medical Center, Prittwitzstrasse43,D89075Ulm,Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Al Ghazal
authors.affiliation: Department of Urology, Ulm University Medical Center, Prittwitzstrasse43,D89075Ulm,Germany.
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Schnoeller
authors.affiliation: Department of Urology, Ulm University Medical Center, Prittwitzstrasse43,D89075Ulm,Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Baechle
authors.affiliation: Department of Urology, Ulm University Medical Center, Prittwitzstrasse43,D89075Ulm,Germany.
authors.forename: Julie
authors.initials: J
authors.lastname: Steinestel
authors.affiliation: Department of Urology, Ulm University Medical Center, Prittwitzstrasse43,D89075Ulm,Germany.
authors.forename: Florian
authors.initials: F
authors.lastname: Jentzmik
authors.forename: Sandra
authors.initials: S
authors.lastname: Steffens
authors.affiliation: Department of Urology, Ulm University Medical Center, Prittwitzstrasse43,D89075Ulm,Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Hirning
authors.affiliation: Department of Urology, Ulm University Medical Center, Prittwitzstrasse43,D89075Ulm,Germany.
authors.forename: Mark
authors.initials: M
authors.lastname: Schrader
authors.affiliation: Department of Urology, Ulm University Medical Center, Prittwitzstrasse43,D89075Ulm,Germany.
authors.forename: Andres J
authors.initials: AJ
authors.lastname: Schrader
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D003161:Compartment Syndromes / Q000209:etiology / Q000601:surgery*; D019299:Decompression, Surgical / Q000009:adverse effects; D005260:Female; D005919:Glomerular Filtration Rate; D006406:Hematoma / Q000209:etiology / Q000601:surgery*; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D007668:Kidney / Q000502:physiology; D007674:Kidney Diseases / Q000209:etiology / Q000601:surgery*; D007902:Length of Stay; D008096:Lithotripsy / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013997:Time Factors; D052878:Urolithiasis / Q000628:therapy
chemical_list: D006454:Hemoglobins