Case Report
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jun 6, 2021; 9(16): 3914-3918
Published online Jun 6, 2021. doi: 10.12998/wjcc.v9.i16.3914
Massive retroperitoneal hematoma as an acute complication of retrograde intrarenal surgery: A case report
Taesoo Choi, Jeonghyouk Choi, Gyeong Eun Min, Dong-Gi Lee
Taesoo Choi, Jeonghyouk Choi, Gyeong Eun Min, Dong-Gi Lee, Department of Urology, School of Medicine, Kyung Hee University, Seoul 05278, South Korea
Author contributions: Choi T reviewed the literature and contributed to manuscript drafting; Choi J reviewed the literature and contributed to manuscript drafting; Min GE performed the disease consultation, and reviewed the literature; Lee DG interpreted the imaging findings and was responsible for the revision of the manuscript for intellectual content; all authors issued final approval for the version to be submitted.
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.
CARE Checklist (2016) statement: The authors have read the CARE Checklist, 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: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Dong-Gi Lee, MD, Doctor, Department of Urology, School of Medicine, Kyung Hee University, 892 Dongnam-ro, Gangdong-gu, Seoul 05278, South Korea. drpedurology@khnmc.or.kr
Received: October 8, 2020
Peer-review started: October 8, 2020
First decision: January 17, 2021
Revised: January 25, 2021
Accepted: April 12, 2021
Article in press: April 12, 2021
Published online: June 6, 2021
Processing time: 212 Days and 4.3 Hours
Abstract
BACKGROUND

Retrograde intrarenal surgery (RIRS) has been proven to be a safe and effective treatment modality in large-scale quantitative studies. However, although its safety profile has been established, it also has a potential risk of life-threatening complications. We here describe our experience with a patient who developed a huge periureteral hematoma after RIRS with holmium laser lithotripsy.

CASE SUMMARY

A 73-year-old woman visited our center with a complaint of gross hematuria. An enhanced computed tomography (CT) scan revealed a 1.5-cm left renal pelvis stone with hydronephrosis. The patient underwent RIRS. During the surgery, a 12/14-Fr ureteral access sheath was applied and a 6-Fr ureteral catheter was indwelled thereafter. On postoperative day 1, she experienced aggravated left flank pain and left lower-quadrant tenderness without rebound tenderness. A follow-up CT scan was taken, which revealed a huge hematoma in the periureteral space, not in the perirenal space, with suspicious contrast medium extravasation. Immediate angiography was performed; however, it showed no evidence of active bleeding. She was conservatively managed with hydration and antibiotic and nonsteroidal anti-inflammatory drug therapy, and was discharged on postoperative day 7. However, she visited our outpatient department with recurrent left flank pain at 5 d from discharge. Ultrasonography confirmed that the double J-stent was intact. To rule out stent malfunction, the stent was changed. Decreased size of the hematoma was observed in the imaging studies, and conservative management for candiduria was performed for 1 wk.

CONCLUSION

Although RIRS is an effective and safe procedure for the management of renal stones, clinicians should be aware of its potential complications.

Keywords: Retroperitoneal hematoma; Ureteral access sheath; Retrograde intrarenal surgery; Acute complication; Case report

Core Tip: Retrograde intrarenal surgery (RIRS) is known as an effective and safe procedure for the management of renal stones. Most of the cases shows excellent clinical outcome, while life threatening complications may occur in some cases. During RIRS, ureteral access sheath (UAS) helps surgeon to reduce operative time as well as potential complications associated with stone retrieval. However, we should remember to manipulate UAS carefully, due to its own risk of ureteral tearing. This case emphasize us to pay attention to acute postoperative pain even after successful RIRS. Additionally, the useful diagnostic suggestions are mentioned based on our experience.