Perinephric Hematoma Following Extracorporeal Shock Wave Lithotripsy: A Comprehensive Review of Four Decades of Evidence on Risk Factors, Prevention, and Management.

Perinephric hematoma represents a significant complication following extracorporeal shock wave lithotripsy (ESWL), with reported incidence ranging from 0.1% to 30% depending on detection methodology. This comprehensive review examines four decades of evidence since the first clinical ESWL treatment in 1980, analyzing risk factors, prevention strategies, and management approaches. Following a systematic literature search, we identified 36 relevant studies encompassing 30,347 treated patients. Hypertension emerges as the dominant modifiable risk factor, increasing hematoma rates from a baseline of 0.66% to 3.8% in poorly controlled patients. Stepwise voltage ramping protocols demonstrate remarkable protective effects, reducing incidence by over 50%. Conservative management succeeds in over 95% of cases, with arterial embolization reserved for active bleeding. Paradoxically, the original Dornier HM3 lithotripter maintains superior safety profiles compared to modern devices despite technological advances. Long-term follow-up studies document complete renal function preservation following appropriate management. These findings inform evidence-based protocols optimizing safety while maintaining treatment efficacy.