Intrarenal arteriovenous malformation following flexible ureterorenoscopy and holmium laser stone fragmentation: report of a case

Flexible ureterorenoscopy (FURS) and holmium laser lithotripsy is currently considered as one of the treatment options for large renal calculi. It has been shown to be safer than percutaneous nephrolithotomy. The latter can sometimes be complicated by the formation of intrarenal arteriovenous malfor...

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Bibliographic Details
Published in:	BMC urology Vol. 19; no. 1; p. 20
Main Authors:	Bashar, Abdelrahman, Hammad, Fayez T
Format:	Journal Article
Language:	English
Published:	England BioMed Central Ltd 22-03-2019 BioMed Central BMC
Subjects:	Aged Angiography Arteriovenous malformation Arteriovenous Malformations - diagnostic imaging Arteriovenous Malformations - surgery Bladder Blood transfusion Calcification (ectopic) Calculi Care and treatment Case Report Case reports CAT scans Chronic kidney failure Computed tomography Diabetes mellitus Diagnostic imaging Extracorporeal shockwave lithotripsy Extravasation Flexible ureterorenoscopy Fur trade Hematoma Hematuria Holmium laser Humans Hypertension Kidney Calculi - diagnostic imaging Kidney Calculi - surgery Kidney diseases Lasers Lasers, Solid-State - therapeutic use Lithiasis Lithotripsy Lithotripsy, Laser - methods Male Medical imaging Pseudoaneurysm Rare earth metal compounds Renal artery Shock waves Surgery Ureteroscopy - methods Urine Urology Flexible ureterorenoscopy Holmium laser Arteriovenous malformation
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Summary:	Flexible ureterorenoscopy (FURS) and holmium laser lithotripsy is currently considered as one of the treatment options for large renal calculi. It has been shown to be safer than percutaneous nephrolithotomy. The latter can sometimes be complicated by the formation of intrarenal arteriovenous malformation (AVM). AVM is extremely rare following FURS and laser lithotripsy. Indeed only one case has been reported on reviewing the literature up to June 2018. We report on the second case illustrating the possibility of developing this major complication following this procedure. A 79 years old diabetic and hypertensive male with stage-4 chronic kidney disease who previously had left extracorporeal shockwave lithotripsy and FURS with Holmium laser lithotripsy, presented with bilateral large renal calculi. He underwent simultaneous bilateral FURS and Holmium laser lithotripsy and was discharged home the following day with almost clear urine. Four days post-discharge, he presented with gross hematuria for which he required hospitalization and blood transfusion. CT scan demonstrated left subcapsular, perinephric and retroperitoneal hematoma. Angiography showed contrast extravasation from pseudoaneurysms in two small branches of left renal artery. Both were selectively embolized with micro-coils and this led to the cessation of the hematuria. Despite the relative safety of FURS and Holmium laser lithotripsy, it can be associated with major complications like intrarenal AVM. This can probably be prevented by careful and judicious use of laser energy in patients with large stone burden and premorbid conditions.
Bibliography:	ObjectType-Case Study-2 SourceType-Scholarly Journals-1 ObjectType-Feature-4 content type line 23 ObjectType-Report-1 ObjectType-Article-3
ISSN:	1471-2490 1471-2490
DOI:	10.1186/s12894-019-0447-7