Percutaneous nephroscopy combined with ultrasound-guided negative-pressure suction for the treatment of perirenal hematoma

Percutaneous renal puncture drainage is needed in patients with perirenal hematoma (PRH, renal around hematoma) with poor conservative treatment. Early and thorough removal of hematoma is closely related to the recovery of patients, but percutaneous renal drainage is not effective in some patients. The clinical data of 5 patients with PRH treated in the first affiliated Hospital of Chongqing Medical University from June 2020 to June 2024 were analyzed retrospectively. There were 4 males and 1 female, with an average age of 58 (43-79) years. The hematoma was located on the left in 2 cases and on the right in 3 cases. The average maximum diameter of hematoma was 10.0 (6.4-13.4) cm. There were 2 cases of fever and low back pain. Three cases were complicated with hypertension. Severe hematuria occurred in 1 case. There were 1 case of PRH after rupture of renal tumor, 1 case of PRH after percutaneous nephrolithotomy, 1 case of PRH after percutaneous renal drainage and 2 cases of PRH after ureteroscopic stent implantation. All the 5 patients underwent percutaneous nephroscopy combined with ultrasound negative pressure aspiration under general anesthesia. The operation time, postoperative drainage tube indwelling time, postoperative hospital stay, treatment effect and complications were analyzed. All the 5 operations were completed successfully, including 3 cases of single channel and 2 cases of double channel. The average operation time was (30-90) min, the average postoperative drainage tube indwelling time was 18 (6-30) days, and the average postoperative hospital stay was 15 (6-36) days. Abdominal computed tomography examination before discharge showed that the PRH was significantly reduced or even disappeared. Among them, 1 patient developed thrombocytopenia, which was related to the long-term use of teicoplanin before operation, and there were no serious complications during and after operation. The average follow-up time was 4 (1-12) months, and there was no recurrence of hematoma. Up to now, there is still no ideal treatment for large PRH. Percutaneous nephroscopy combined with ultrasound negative pressure aspiration under general anesthesia might be a feasible method for the treatment of giant renal around hematoma.