Editorial Comment from Dr Kanno to subcapsular renal hematoma after ureterorenoscopy.

Retrograde intrarenal surgery using ureteroscopy for urinary calculi has recently become the standard treatment, and the indication is also expanding. However, there are some complications specific to ureteroscopy, and in fact, perioperative deaths have been reported. , Therefore, it is essential that urologists become familiar with the complications associated with this operation.

Here, Harada et al. reported a case of subcapsular hematoma after ureteroscopic surgery for renal stones. This is a very important report, and the clinical course appears to be instructive. Subcapsular hematoma after extracorporeal shock wave lithotripsy for renal calculi is well known, but there are limited reports of subcapsular hematoma after ureteroscopy. We recently reported a subcapsular hematoma following ureteroscopy in our hospital. The incidence was 0.4% (5 of 1235), which was similar to that reported in a systemic review (0.45%; range 0.15–8.9%).

Risk factors for postoperative subcapsular hematoma include hydronephrosis, hypertension, diabetes, urinary tract infection, patient performance status, prolonged operative time, and increased intraoperative intrapelvic pressure. Among them, operation time and intraoperative intrapelvic pressure are factors that depend on the operator and are very critical factors because they are also involved in the development of postoperative pyelonephritis. Therefore, urologists should be aware of the possibility of subcapsular hematoma following ureteroscopy and try to avoid shortening the operative time and increasing intrapelvic pressure. In order to detect subcapsular hematoma in the early postoperative period, we routinely perform ultrasound on postoperative days 1–3, and it is strongly recommended to do so at least in symptomatic cases. In addition, we should be familiar with how to deal with renal subcapsular hematoma when it occurs.

Conflict of interest

The author does not have any conflicts of interest to declare.