E5482. Case-Based CT Review of Complications After Interventional Treatment of Urolithiasis
  1. Rania Anan; Ministry of Health
  2. Anand Singh; Envision Healthcare
  3. Narayan Viswanadhan; University of South Florida
  4. Ahmed Abd El-Karim; Cairo University
By the end of this exhibit, the participant should learn the different minimally invasive methods of treatment of urolithiasis, including extracorporeal shock-wave lithotripsy (ESWL) and percutaneous nephrolithotomy (PCNL), and understand the main complications following these procedures, as well as the role of multidetector CT in the assessment of these postprocedural complications.

Educational Goals / Teaching Points
In this exhibit, we will discuss the minimally invasive methods of treatment of urolithiasis including ESWL and PCNL. Elaborate the most common complications after interventional treatment of urolithiasis including steinstrasse, bleeding, severe infections, collecting system, ureteral injuries, and strictures. Understand the role of CT in the early diagnosis of complications from renal intervention, which can improve the patient’s prognosis and aid in making the choice between conservative, surgical, endoscopic, or interventive treatment of these complications. Provide case-based examples to understand the CT findings of postprocedural complications.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
It is important for the radiologist to understand the common complications of renal interventions. An understanding of early and delayed complications from a variety of renal interventions will allow the radiologist to direct prompt and appropriate management. Appropriate patient selection for interventional treatment of urolithiasis, with consideration of possible contraindications, close monitoring of treated patients for the development of postprocedural complications, and prompt use of MDCT imaging help prevent the occurrence and lessen the magnitude of complications.

Complications following interventional treatment of urolithiasis are increasingly encountered. Prompt recognition of the complications in imaging is vital, particularly as some of them can be life-threatening. Unenhanced MDCT is highly useful to diagnose most of these complications. However, if the patients’ clinical and/or laboratory data or unenhanced MDCT findings suggest a significant complication, a prompt contrast-enhanced MDCT examination is considered the mainstay technique to provide a rapid, comprehensive assessment of renal, vascular, and ureteral injuries. It allows reliable detection and quantification of retroperitoneal hemorrhage, differentiation from fluid collections or extravasated urine, and identification of active bleeding, thus allowing an accurate assessment of the injury’s severity, a correct therapeutic choice, and reliable follow-up during conservative treatment.