CLINICALLY DIAGNOSED RENAL HEMORRHAGE AFTER EXTRACORPOREAL SHOCK-WAVE LITHOTRIPSY WITH DORNIER HM3 AND MEDSTONE LITHOTRIPTERS

Of 6765 patients having extracorporeal shock wave lithotripsy (SWL) with either a Dornier HM3 or a Medstone STS lithotripter to 7381 kidneys, 7 (0.1 %) developed clinically significant renal hemorrhage diagnosed by persistent pain, increasing hematuria, or a drop in hemoglobin in excess of 2 g/ml and confirmed by retrograde pyelography or ultrasound or CT scanning. Blood transfusion was required in one patient, and all seven patients were managed expectantly, with one patient having an unsuccessful attempt at percutaneous drainage of suspected infection of the hematoma at 4 weeks post-SWL. Pre-existing hypertension was present in three patients. Aspirin intake was present in four patients, and abnormal platelet aggregation studies were present in one of these patients 7 days after ceasing aspirin intake. It is important that patients be specifically questioned regarding aspirin intake, as some patients do not regard aspirin as a medication. Shock wave lithotripsy should be performed no earlier than 2 weeks after cessation of aspirin intake.