The authors report 24 cases of spontaneous non traumatic retroperitoneal hematoma caused by various conditions of urological interest in more than 25 years experience at the Urologic Clinic of Genoa: neoplasms 42% (RCC 21%, transitional 4%, angiomyolipoma 17%), inflammatory disease 29%, lithiasis 8%, vascular disease 8% (rupture aneurysm of the renal artery 4%, artero-venous fistula 4%), cysts 4%, coagulopathies 4%, adrenal disease 4%. Iatrogenic retroperitoneal hematomas secondary to ESWL treatment should be considered separately; in our series they amount to 6 in 11,000 treatments which equals 0.05%. 2 cases among these required nephrectomy. Spontaneous urological retroperitoneal hematoma is a rare clinical event (described in the world literature in only a few hundred cases) which presents with acute lumbar and abdominal pain and in more serious cases with signs of anemia and shock; where there is also abdominal swelling the triad of Lenk is complete. Treatment was nephrectomy plus capsulectomy with or without conservation of the adrenal in 37% of cases, radical nephrectomy in 33%, partial nephrectomy in 17%, conservative surgery (capsulectomy with/without nephrorrhaphy) in 8%, nephroureterectomy in 4%. In our series no intra or peri-operative deaths secondary to anemia and/or the etiology of retroperitoneal hematoma were observed; one HIV positive patient died from septic complications a month after surgery. One patient submitted to nephrectomy for post-ESWL hematoma died one month after surgery for bleeding from the esophageal varices, a result of unrecognized liver cirrhosis.
|Number of pages||5|
|Journal||Acta Urologica Italica|
|Publication status||Published - 1995|
- spontaneous retroperitoneal hematoma
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