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Subretinal hemorrhage after mini-percutaneous nephrolithotomy
1 Urologist, MD, PhD, Deputy Director for Medical Affairs (Urology) of the Clinic for Pirogov High Medical Technologies, Saint-Petersburg, Russia
2 Urologist, MD, Endourology Department of Pavlov State Medical University, Saint-Petersburg, Russia
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Ibragim Malikiev
Urologist, MD, Endourology Department of Pavlov State Medical University, Saint-Petersburg,
Russia
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Article ID: 100034Z15NG2023
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Gadzhiev NK, Obidnyak VM, Gorelov DS, Malikiev I, Mischenko AA. Subretinal hemorrhage after minipercutaneous nephrolithotomy. J Case Rep Images Urol 2023;8(2):6–8.ABSTRACT
No Abstract
Keywords: Body mass index, Magnetic resonance imaging, Subretinal hemorrhage
Case Report
A 44-year-old female with a left kidney stone measuring 1.8 × 1.5 cm and with a density of up to +1370 HU was prepared for mini-percutaneous nephrolithotomy. The concomitant pathology included obesity [body mass index (BMI) 37.1 kg/m2], arterial hypertension, and type 2 diabetes mellitus. The surgery was performed under general anesthesia in the modified Galdakao-Valdivia position. Moreover, mini-percutaneous nephrolithotomy (PCNL) was performed without any peculiarities (Figure 1). We found that the patient’s vital functions were stable at the end of the operation; however, at the extubation stage, the patient had a hypertensive crisis. The arterial pressure was normalized in the OR.
In the first hours after surgery, the patient started complaining about decreased visual acuity and the presence of a floating spot in the right eye. An examination by the ophthalmologist on direct ophthalmoscopy revealed subretinal hemorrhage in the right eyeball. Furthermore, we performed an optical coherence tomography of the eye and magnetic resonance imaging (MRI) of the eye cavity with contrast enhancement, which confirmed the presence of subretinal hemorrhage in the right eyeball (Figure 2). The patient reported no history of hemorrhage, clotting disorders, COVID-19, or anticoagulant therapy, but she had arterial hypertension and impaired glucose tolerance, which might be triggering factors in her concomitant pathology. Therefore, hemostatic therapy with antifibrinolytic agents was recommended for the patient. On the sixth day after the operation, repeated ophthalmoscopy demonstrated positive dynamics in the form of a decrease in the SC size. During the follow-up which was conducted three weeks after the operation, the vision of the patient recovered completely.
Discussion
Subretinal hemorrhage is an accumulation of blood between the retinal pigment epithelium and the neurosensory epithelium, which often causes its extensive detachment. In clinical practice, this pathology is quite rare. All cases of SC described in the literature have at least one predisposing factor. Systemic risk factors include anticoagulants, blood dyscrasia, malignant tumors in the decay stage, arterial hypertension, and diabetes mellitus, while macular subretinal neovascularization and retinal blood supply abnormalities are among the ophthalmic risk factors. Therefore, timely diagnosis of SC and timely treatment are the cornerstones of controlling this complication [1],[2],[3],[4],[5],[6].
We suppose that the hypertensive crisis at the extubation stage is the main trigger for subretinal hemorrhage which appeared in the background of hypertonic and diabetic retinopathy.
Conclusion
This paper described an atypical complication that emerged after mini-percutaneous nephrolithotomy. Even in ophthalmologic practice, subretinal hemorrhage is rather rare pathology. However, the probability of its occurrence should be taken into account in patients with diabetes mellitus and hypertension.
REFERENCES
1.
Murray CJL, Lopez AD. Measuring global health: Motivation and evolution of the Global Burden of Disease Study. Lancet 2017;390(10100):1460–4. [CrossRef]
[Pubmed]
2.
Je Y, Schutz FAB, Choueiri TK. Risk of bleeding with vascular endothelial growth factor receptor tyrosine-kinase inhibitors sunitinib and sorafenib: A systematic review and meta-analysis of clinical trials. Lancet Oncol 2009;10(10):967–74. [CrossRef]
[Pubmed]
3.
Patel SR, Nakada SY. The history and development of percutaneous nephrolithotomy. The History of Technologic Advancements in Urology 2017;15(7):123–32.
4.
Palapattu GS, Bloom DA, Smith RB, Boxer RJ. Willard E. Goodwin: Educator, innovator and pioneer. J Urol 2004;172(1):40–4. [CrossRef]
[Pubmed]
5.
Yau JWY, Lee P, Wong TY, Best J, Jenkins A. Retinal vein occlusion: An approach to diagnosis, systemic risk factors and management. Intern Med J 2008;38(12):904–10. [CrossRef]
[Pubmed]
6.
Kilickap S, Abali H, Celik I. Bevacizumab, bleeding, thrombosis, and warfarin. J Clin Oncol 2003;21(18):3542. [CrossRef]
[Pubmed]
SUPPORTING INFORMATION
Author Contributions
NK Gadzhiev - Conception of the work, Design of the work, Acquisition of data, Analysis of data, Drafting the work, Revising the work critically for important intellectual content, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
VM Obidnyak - Conception of the work, Design of the work, Acquisition of data, Analysis of data, Drafting the work, Revising the work critically for important intellectual content, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
DS Gorelov - Conception of the work, Design of the work, Acquisition of data, Analysis of data, Drafting the work, Revising the work critically for important intellectual content, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Ibragim Malikiev - Conception of the work, Design of the work, Acquisition of data, Analysis of data, Drafting the work, Revising the work critically for important intellectual content, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
AA Mischenko - Conception of the work, Design of the work, Acquisition of data, Analysis of data, Drafting the work, Revising the work critically for important intellectual content, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Guaranter of SubmissionThe corresponding author is the guarantor of submission.
Source of SupportNone
Consent StatementWritten informed consent was obtained from the patient for publication of this article.
Data AvailabilityAll relevant data are within the paper and its Supporting Information files.
Conflict of InterestAuthors declare no conflict of interest.
Copyright© 2023 NK Gadzhiev et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.
