Case Report
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Sep 26, 2022; 10(27): 9954-9960
Published online Sep 26, 2022. doi: 10.12998/wjcc.v10.i27.9954
Renal pseudoaneurysm after rigid ureteroscopic lithotripsy: A case report
Yi Hong Li, Yi Sheng Lin, Chao Yu Hsu, Yen Chuan Ou, Min Che Tung
Yi Hong Li, Yi Sheng Lin, Chao Yu Hsu, Yen Chuan Ou, Min Che Tung, Division of Urology, Department of Surgery, Tungs' Taichung MetroHarbor Hospital, Taichung 43503, Taiwan
Author contributions: Li YH was responsible for the conception and design of the work as well as data analysis and interpretation; Lin YS was a supervisor and participated in the care of the patient; Li YH drafted the article; Hsu CY, Ou YC and Tung MC reviewed the article; all authors have read and approved the final manuscript.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest to disclose.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Yi Sheng Lin, MD, Chief Physician, Division of Urology, Department of Surgery, Tungs' Taichung MetroHarbor Hospital, No. 699 Section 8, Taiwan Boulevard, Wuqi District, Taichung 43503, Taiwan.
Received: May 25, 2022
Peer-review started: May 25, 2022
First decision: June 16, 2022
Revised: June 28, 2022
Accepted: August 16, 2022
Article in press: August 16, 2022
Published online: September 26, 2022

Ureteroscopic lithotripsy (URSL) is a common surgical treatment for ureteral stones. Although flexible ureteroscopy can be used to treat ureteral and renal stones in a single procedure, rigid ureteroscopy can only be used to treat ureteral stones; nonetheless, rigid ureteroscopy remains mainstream in Taiwan owing to its late introduction and flexible ureteroscopy is not covered by national health insurance. Hematuria is a common complication that occurs when the scope passes through stricture sites or when mucosal damage occurs during lithotripsy, but this is usually self-limited. Prolonged hematuria requiring intervention is termed persistent hematuria. Persistent hematuria is less common and few studies have reported the development and etiology of renal pseudoaneurysm after flexible ureteroscopy for renal stones. Herein, we present the first reported case of renal pseudoaneurysm after rigid URSL for ureteral stone.


The patient was a 57-year-old man who developed renal pseudoaneurysm with active bleeding after rigid ureteroscopy. He presented with gross hematuria and intolerable left flank pain after left URSL. Severe anemia was noted (hemoglobin level, 6.8 g/dL). Contrast enhanced computed tomography revealed one pseudoaneurysm each in the upper and lower renal cortex. He was managed via transcatheter arterial embolization with microcoils, which relieved the symptoms.


To the best of our knowledge, ours is the first case report on renal pseudoaneurysm after rigid URSL. Because renal pseudoaneurysms are difficult to access, underlying hypertension, clinical signs such as refractory flank pain, and gross hematuria should be carefully monitored following similar endourological procedures.

Keywords: Aneurysm, False, Ureteroscopy, Lithotripsy, Intraoperative complication, Embolization, Therapeutic, Case report

Core Tip: To the best of our knowledge, no studies have reported renal pseudoaneurysm as a complication of rigid ureteroscopy for ureteral stones, although renal pseudoaneurysm following flexible ureteroscopic lithotripsy has been reported. Here, renal pseudoaneurysm may have existed but was exacerbated by surgery or indirectly formed due to increased renal pelvis pressure. The etiology was not clarified because computed tomography was not routinely performed preoperatively. Perioperative cough may play a role owing to a sudden increase in abdominal pressure. Based on our literature review, this is the first case report of renal pseudoaneurysm without direct intervention in the renal pelvis.