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Objective: To evaluate risk factors, clinical presentation, therapeutic management, and treatment of residual stones and subsequent development of renal hematoma following Extracorporeal Shock Wave Lithotripsy (ESWL). Material and methods: A retrospective review was made of 31 post-ESWL renal hematoma cases diagnosed between May 1987 and June 1996. Lithotripsy treatments were outpatient procedures without anaesthesia. Our center has three electromagnetic sources, two with biplane X-ray centering and one ultrasound-guided (SIEMENS Lithostar II®, SIEMENS Lithostar System C® and SIEMENS Lithostar Ultra®, respectively). We analysed findings from patient history, physical examination, blood analysis, and renovesical sonographs. Follow-up involved periodical checks, blood analyses and renovesical sonographs, scheduled first at three-month intervals and later at six-month intervals. Results: Our center performed 21 699 lithotripsies on a total of 10 953 patients in this period. Thirty-one renal hematomas were diagnosed, giving an incidence rate of 0.28%. Twenty-four patients presented clinical onsets and the commonest symptom for consultation was low back pain (74%). Eleven patients of this group (46%) were hypertensive. All patients received conservative treatment. With a mean follow-up time of 18 months, ultrasound showed persistent hematoma in 11 patients (36%). There were residual stones in 71% of patients; further lithotripsy was performed on seven patients with no clinical or ultrasonographic signs of change in the hematoma. Conclusions: Renal hematoma post-ESWL is a rare complication. Main risk factors are hypertension, clotting disorders and previous ESWL sessions. Flank pain is the main symptom at presentation. Elective management is conservative. Presence of hematoma is not a contraindication for further treatments of residual stones. [ABSTRACT FROM AUTHOR]

Objectives: To know the factors associated to a successful result in the treatment of kidney transplant lithiasis by extracorporeal shockwave lithotripsy (ESWL)., Methods: From 850 kidney transplants performed at our center, we analyze 15 patients who developed urinary stones. Successful result by ESWL was the dependent variable, and size, location, and multiplicity of the stones were independent variables. Associations between variables were studied by the chi-square test (categorical variables) and the U-Mann Whitney test (continuous variables)., Results: Incidence was 1.76%. ESWL effectiveness was 87%; it was greater in solitary stones than in multiple stones (p = 0.001). No significant differences were found for stone size, although largest stones had a high risk for insertion of a nephrostomy tube (p = 0.013). Finally, ESWL was more effective for stones located at the ureteral anastomosis, although this difference was found not significant., Conclusions: The treatment of kidney transplant lithiasis by ESWL has an effectiveness of 87%. The best result was found for solitary stones located at the ureteral anastomosis.