Spontaneous urinoma diagnosed before radical cystectomy: A case report

Abstract

Introduction. Rupture of the urinary collecting system, associated with perirenal or retroperitoneal extravasation of the urine, is a rare condition usually associated with the obstruction of the urinary system. A urinoma is a localized collection of urine in the retroperitoneum, outside the urinary tract, and occurs after injury to the wall of the urinary system. Ureteral obstruction caused by a bladder tumor is a rare cause of urinoma. Case Report. We report a case of a 62-year-old patient who was admitted to the Clinic of Urology of the Clinical Center of Serbia, due to an invasive bladder cancer. A computerized tomography scan of the abdomen and pelvis revealed a massive bladder tumor dominant on the left side, invading the vagina, uterus and significantly obstructing both kidneys. Intraoperatively, a mass of 18 cm in diameter was identified in the right retroperitoneal space and it was dissected from the peritoneum. Two liters of clear fluid were aspirated from the mass, and the walls of urinoma were resected. The site of perforation was not identified. The patient underwent anterior pelvic exenteration. The pathohistological analysis revealed a high grade transitional cell carcinoma of the bladder. The treatment is individual and involves surgical and interventional radiology treatment. Conclusion. A spontaneous retroperitoneal urinoma is a very rare condition. In this case report it appeared most likely due to right ureteral obstruction and perforation. The growth of urinoma was slow, due to the absence of acute symptoms and the thickness of the urinoma wall.