Spontaneous non traumatic hematomas of urological interest. More than 25 years of experience

The authors report 24 cases of spontaneous non traumatic retroperitoneal hematoma caused by various conditions of urological interest in more than 25 years experience at the Urologic Clinic of Genoa: neoplasms 42% (RCC 21%, transitional 4%, angiomyolipoma 17%), inflammatory disease 29%, lithiasis 8%, vascular disease 8% (rupture aneurysm of the renal artery 4%, artero-venous fistula 4%), cysts 4%, coagulopathies 4%, adrenal disease 4%. Iatrogenic retroperitoneal hematomas secondary to ESWL treatment should be considered separately; in our series they amount to 6 in 11,000 treatments which equals 0.05%. 2 cases among these required nephrectomy. Spontaneous urological retroperitoneal hematoma is a rare clinical event (described in the world literature in only a few hundred cases) which presents with acute lumbar and abdominal pain and in more serious cases with signs of anemia and shock; where there is also abdominal swelling the triad of Lenk is complete. Treatment was nephrectomy plus capsulectomy with or without conservation of the adrenal in 37% of cases, radical nephrectomy in 33%, partial nephrectomy in 17%, conservative surgery (capsulectomy with/without nephrorrhaphy) in 8%, nephroureterectomy in 4%. In our series no intra or peri-operative deaths secondary to anemia and/or the etiology of retroperitoneal hematoma were observed; one HIV positive patient died from septic complications a month after surgery. One patient submitted to nephrectomy for post-ESWL hematoma died one month after surgery for bleeding from the esophageal varices, a result of unrecognized liver cirrhosis.