Abstract
Extracorporeal shock wave lithotripsy (ESWL), percutaneous nephrolithotomy (PCNL) and ureteroscopy (URS) currently represent the mainstay treatment options for the vast majority of patients with urolithiasis, with limited contraindications and high success rates. However, minimally invasive extracorporeal and endourological treatments are associated with a non-negligible morbidity including occasional life-threatening occurrences. These complications represent a source of concern for urologists since they may result in prolonged hospitalisation, need for surgical, endoscopic or interventional treatment, long-term renal impairment, and sometimes even medical malpractice claims. Due to the increasing prevalence of urolithiasis and the large number of therapeutic procedures performed, in hospitals with active urologic practices radiologists are increasingly requested to investigate suspected post-procedural complications following ESWL, PCNL or ureteroscopic stone removal. Based upon our experience, this pictorial essay provides an overview of current extracorporeal and endourological treatment modalities for urolithiasis, including indications and possible complications according to the most recent guidelines from the European Association of Urology (EAU). Afterwards, we review the clinical features and cross-sectional imaging appearances of common and unusual complications with case examples, including steinstrasse, subcapsular, perirenal and suburothelial haemorrhages, severe urinary tract infections (such as pyeloureteritis, pyelonephritis, renal abscesses and pyonephrosis), ureteral injuries and delayed strictures. Teaching points • Extracorporeal lithotripsy, percutaneous nephrolitotomy and ureteroscopy allow treating urolithiasis. • Minimally invasive extracorporeal and endourological treatment have non-negligible morbidity. • Multidetector CT allows confident assessment of stone-free status and postprocedural complications. • Main complications include steinstrasse, bleeding, severe infections, ureteral injuries and strictures. • Imaging triage allows the choice among conservative, surgical, endoscopic or interventive treatment.
Highlights
BackgroundUrolithiasis represents one of the most common urogenital disorders and occurs in approximately 4–5 % of the general population in European countries
The increasing prevalence and incidence of urolithiasis reported over the last decades probably results from the combined effects of nutritional changes, environmental factors and improved diagnosis, with the extensive use of unenhanced multidetector Computed Tomography (CT) (MDCT) [1, 2]
During the last 30 years, modern extracorporeal and endourological therapies have revolutionised the field of urology and dramatically reduced the number of surgical procedures, which are second- or third-line treatment options reserved for only 1–1.5 % of patients
Summary
Urolithiasis represents one of the most common urogenital disorders and occurs in approximately 4–5 % of the general population in European countries. In the USA, the lifetime risk of symptomatic kidney stones has been estimated to approximate 13 % in men and 7 % in women, leading to substantial cost in terms of emergency department visits, use of imaging and treatment. During the last 30 years, modern extracorporeal and endourological therapies have revolutionised the field of urology and dramatically reduced the number of surgical procedures, which are second- or third-line treatment options reserved for only 1–1.5 % of patients. Iatrogenic complications represent a source of concern for urologists since they may require prolonged hospitalisation and additional surgical, endoscopic or interventional treatment, may have detrimental effects on renal function and sometimes even lead to medical malpractice claims [4,5,6]
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