Extracorporeal Shock-Wave Lithotripsy: Increased Risk for Hematoma Formation by Acetylsalycic Acid?
Extracorporeal shock-wave lithotripsy (ESWL) is a world-wide established treatment modality for renal and ureteral stones. The main immediate sideeffects are ureteral obstruction with formation of so-called “steinstrasse” with the risk of urosepsis in case of concomitant urinary tract infection, and the occurrence of subscapular and/or perirenal hematomas. Severe perirenal hemorrhage with clinical symptoms is a rare event, with a reported incidence of 0.3 to 1.5%. With the use of more sensitive diagnostic procedures like CT-scanning and MRI, hematomas are diagnosed in up to 24% of patients (1), even though the majority of these events remains clinically unrecognized. Most investigators were unable to document a relationship between the incidence of hematoma formation and the impulse numbers of the generator voltage used. There are few experimental studies on the pathogenesis of these bleeding events and their morphological basis. One risk factor seems to be uncontrolled hypertension. It has been speculated that the intake of aspirin with its inhibitory action on platelet aggregation may be another responsible factor.
KeywordsUreteral Stone Ureteral Obstruction Hematoma Formation Generator Voltage Perirenal Hematoma
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- 1.JV Kaude, CM Williams, MR Millner, KN Scott, and B Finlayson, Renal morphology and function immediately after extracorporeal shock-wave lithotripsy, Am. J. Radiol. 145:305 (1985).Google Scholar