Concurrent septic shock and massive renal hematoma following flexible ureteroscopy resulting in emergency nephrectomy: a case report

Abstract

BACKGROUND: Flexible ureteroscopy (FURS) is widely considered a safe and effective modality for renal stone management. Severe infectious and hemorrhagic complications are uncommon but may be life-threatening. CASE-PRESENTATION: A 75-year-old man was referred to our tertiary center with hemodynamic instability following FURS performed at an outside institution for the treatment of a renal calculus. He presented with septic shock and acute anemia. Contrast-enhanced computed tomography revealed a massive perirenal hematoma compressing the renal parenchyma. Despite aggressive resuscitation, broad-spectrum antibiotics, and intensive care management, the patient's clinical condition deteriorated. Emergency nephrectomy was performed as a life-saving intervention. CONCLUSION: This case highlights the potential for rare combined septic and hemorrhagic complications following FURS. Early recognition and timely referral to specialized centers are critical to reducing mortality and optimizing patient outcomes.