We report a case of large bilateral perirenal and intrarenal hematoma formation leading to prolonged anuria in the absence of obstruction following extracorporeal shock wave lithotripsy. With conservative management, including the need for hemodialysis support, renal function gradually returned. A mechanism for this patient's anuric renal failure is postulated and caution is advised when considering simultaneous bilateral extracorporeal shock wave lithotripsy in patients with a potential risk of bleeding.
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