Urinomas Associated With Posterior Urethral Valves

Abstract

We evaluated the incidence and clinical implications of urinomas in boys with posterior urethral valves. Our secondary aim was to evaluate the treatment modalities of urinomas. We retrospectively reviewed the hospital data of 200 patients with posterior urethral valves treated between 1953 and 2003. Documentation was sufficient in 196 cases to evaluate the presence of urinomas. A group of 69 patients with posterior urethral valves without urinoma served as controls. Of 196 patients 17 (9%) had urinoma. However, the incidence of urinoma increased to 15% after ultrasonography came into standard clinical use. Nine patients had perirenal urine collection, 6 had urinary ascites and 2 had urinothorax. At presentation median serum creatinine values were similar in patients with urinoma (145 mumol/l, range 54 to 431) and controls (126 mumol/l, 19 to 593, p = 0.547). Creatinine decreased similarly in patients with and without urinoma after the obstruction was relieved. Vesicoureteral reflux was detected in 69% of the patients with urinoma and in 76% of the controls. Median split function on the side of the urinoma was 51% (range 38% to 70%) on (99m)technetium diethylenetetramine pentaacetic acid scintigraphy. During childhood end-stage renal failure developed in 4 of the 16 patients (25%) with urinoma and in 16 of the 69 controls (23%). The true incidence of urinomas is probably close to 15% in patients with posterior urethral valves. Renal function is similar in patients with posterior urethral valves with and without urinoma. In asymptomatic cases urinomas apparently do not require any specific treatment.