Published online Sep 26, 2022. doi: 10.12998/wjcc.v10.i27.9954
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.
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.