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Ureterstriktur nach extrakorporaler Stoßwellenlithotripsie

Kasuistik und Übersicht über das Spektrum seltener Nebenwirkungen der modernen ESWL-Therapie

Ureteral stricture after extracorporeal shock wave lithotripsy

Case report and overview of the spectrum of rare side effects of modern ESWL treatment

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Zusammenfassung

Die extrakorporale Stoßwellenlithotripsie (ESWL) gilt als sehr sichere, nicht-invasive Behandlungsform der Urolithiasis. Durch technische Weiterentwicklungen sind Komplikationen im Verhältnis zur Anwendungshäufigkeit immer seltener geworden. Aus unserem Patientenkollektiv entwickelte eine Patientin mit Zystinurie in Folge mehrfacher ESWL-Sitzungen eine temporäre Ureterstriktur. Auf der Basis dieser Beobachtung wurde eine Medline-Recherche durchgeführt, um das Spektrum seltener aber relevanter Komplikationen bei der modernen Lithotripsie abzubilden.

Neben der Nierenstauung und Koliken stellen renale und perirenale Hämatome in bis zu 4% in größeren Serien die häufigste Nebenwirkung dar. Seltene extrarenale Komplikationen werden überwiegend in Einzelfallberichten dargestellt, auf die in dieser Arbeit näher eingegangen werden soll. Über Verletzungen innerer Organe (Leber, Milz, Darm, Pankreas) wurde am häufigsten berichtet. Daneben fanden sich Berichte über die Ruptur bzw. Dissektion eines Bauchaortenaneurysmas als besonders schwerwiegende Komplikation.

Unter Beachtung der bekannten Kontraindikationen und sorgfältiger Vorbereitung (Medikamentenanamnese, Blutgerinnungsstatus) der Patienten stellt die ESWL ein äußerst sicheres Verfahren mit einer niedrigen Komplikationsrate dar. Auch im Hinblick auf die zunehmende ambulante Therapie sollte jedoch prä- und postoperativ eine sorgfältige klinische und sonographische Untersuchung erfolgen.

Abstract

Extracorporeal shock wave lithotripsy (ESWL) is considered a very safe and noninvasive procedure for the treatment of urolithiasis. Achievements in the technical development of recent decades resulted in a continuous reduction of side effects. One of our patients, a woman with cystinuria, developed a temporary ureteral stricture after several sessions of ESWL. Encouraged by this observation we set out to explore – based on a MEDLINE literature search – published reports of more severe side effects observed in modern ESWL therapy.

Besides hydronephrosis and renal colic the most common side effects were renal and perirenal hematomas in up to 4% in the larger series. Uncommon extrarenal complications are described mostly in case reports, which are also outlined in this report. The injury of visceral organs (liver, spleen, gut, pancreas) was published most frequently. A rupture or dissection of an abdominal aortic aneurysm as an outstanding serious complication was also reported several times.

Taking obvious and well-known contraindications into consideration and carefully preparing the patients for the therapy (i.e., checking hemostasis, drug history), ESWL is a very safe procedure with a low risk of serious complications. Yet, postoperative clinical and ultrasound monitoring seems to be essential especially with respect to the increasing numbers of outpatient procedures.

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  1. Abteilung für Urologie und Kinderurologie, Urologische Universitätsklinik, Universität, Prittwitzstraße 43, 89075, Ulm, Deutschland

    F. Finter, L. Rinnab, J. Simon, B. Volkmer, R. Hautmann &  R. Kuefer

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  1. F. Finter
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  2. L. Rinnab
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Correspondence to R. Kuefer.

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Finter, F., Rinnab, L., Simon, J. et al. Ureterstriktur nach extrakorporaler Stoßwellenlithotripsie. Urologe 46, 769–772 (2007). https://doi.org/10.1007/s00120-007-1334-5

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