Case Of Urinoma Research Articles

The role of point-of-care ultrasound in the assessment of pelvic urine leakage and diagnosis of urinoma

BackgroundUrinoma, a rare condition resulting from urine leakage due to trauma to the kidney, bladder, or urethra, is typically diagnosed using enhanced computed tomography urogram with delayed imaging. This report presents two cases of urinoma likely caused by overdistention of the renal pelvis following excessive fluid intake and the presence of a ureteral stone.Case presentationWe present two cases of 36-year-old and 38-year-old patients who presented with flank pain. point-of-care ultrasound (POCUS) played a pivotal role in identifying perinephric fluid in Morrison’s space and the splenorenal space, respectively. These ultrasound findings guided further investigations, leading to definitive diagnoses via abdominal pelvic CT scans. Treatment involved prophylactic antibiotics and the successful placement of a double J stent into the renal pelvis over the wire under fluoroscopic guidance, which resulted in significant clinical improvement for both patients.ConclusionsThis study demonstrates the rare occurrence of urinoma from urolithiasis, the use of POCUS in expediting diagnosis and treatment, and the importance of interpreting sonographic images in the correct clinical setting.

Risk factors for adverse outcomes after pediatric pyeloplasty: A retrospective cohort study.

To identify the risk factors for adverse outcomes after pediatric pyeloplasty. We conducted a retrospective review of all children under the age of 14 years who underwent primary pyeloplasty for unilateral ureteropelvic junction (UPJ) obstruction at a single teaching hospital in Tunisia between January 1, 2013, and December 31, 2022. A total of 103 patients were included. Median age of patients at surgery was 27 months (interquartile range [IQR], 13-44). On ultrasound, median renal pelvic anteroposterior diameter was 3.2 cm (IQR, 2.3-4), and the median renal cortex thickness (RCT) was 2.5 mm (IQR, 2-3.5). Median differential renal function (DRF) on preoperative radionuclide renal scan was 40% (IQR, 30-46). Postoperative adverse outcomes occurred in 28 patients (27.2%). These included 19 cases of urinary tract infections (UTIs), 11 cases of UPJ restenosis, four cases of UPJ leakage, two cases of urinoma, and two cases of diversion-related complications. Multivariate logistic regression analysis revealed two factors significantly and independently related to postoperative negative outcomes: RCT <3 mm and DRF > 50%. Our study demonstrated that preoperative RCT on ultrasound of less than 3 mm and preoperative DRF on radionuclide renal scan of more than 50% were independent risk factors for adverse outcomes following pediatric pyeloplasty. These factors could be of interest in identifying, early on, patients who will develop postoperative negative outcomes, giving them more attention and support, and explaining the prognosis to the patient and family.

Delayed Surgery to Preserve Kidney with Grade IV Injury.

Background Since the introduction of the ALARA (“as low as reasonably achievable”) concept, the management of severe renal trauma has shifted. Our hospital promotes delayed surgical intervention for grade IV closed renal injury, to preserve renal function. In this study, we retrospectively reviewed the management and outcomes of patients with grade IV closed renal injury in our hospital. Objective To evaluate the management and outcome of grade IV closed renal injury. Methods We retrospectively reviewed the medical records of 45 patients with grade IV closed renal injury; namely, 36 men and 9 women with an average age of 35.6 years. All patients were diagnosed with grade IV closed renal injury in accordance with the guidelines of the American Association for the Surgery of Trauma. All hemodynamically-stable patients with renal trauma were treated conservatively for approximately 13 days and then underwent surgery only to clear the perirenal hematoma and not to repair or resect the affected kidney. ed data included patient demographics, mechanism of injury, admission hemodynamics, CT findings, and mortality. The primary outcome was the success rate of nonsurgical treatment, and the secondary outcome was the complication of nonsurgical treatment. Results All patients responded and were discharged, and no patients died. We followed 35 (77.8%) patients for at least 1 year. One patient with partially devitalized renal parenchyma underwent surgery to remove the affected kidney. Eleven patients (31.4%) suffered complications, namely, three (8.6%) cases of hypertension, four (11.4%) cases of hematuria, two cases (5.7%) of urinary tract infection, and two (5.7%) cases of urinoma. Conclusions Delayed exploratory surgery only to remove the hematoma should be considered in hemodynamically-stable patients with grade IV closed renal injury. This approach can avoid high nephrectomy rates associated with emergency surgery and reduce the complications that result from conservative treatment without surgery.

Urinoma: Saviour of beleaguered kidney

Introduction: Spontaneous extravasation of urine due to High Pressure Chronic Retention is a rare entity. Most cases of urinoma are secondary to ureteric calculi. We present a case of left spontaneous perinephric urinoma with right hydroureteronephrosis with high pressure chronic retentiondue to benign enlargement of prostate. Summary: A 70 years male, with no comorbid illness, presented with left flank pain with overflow incontinence. On radiological evaluation, he was found to have distended urinary bladder, with right hydrouretronephrosis and left perinephric collection. Renal function tests were deranged. Patient was managed with per urethral catheter placement, antibiotics and ultrasound guided aspiration. Retention volume was more than one litre. Creatinine content of aspirated fluid was ten times higher to serum creatinine. Transurethral resection of prostate was done. The patient voided well after surgery. The urinoma resolved completely in 2 weeks. Follow up Contrast study revealed preserved left renal function; however the right hydroureteronephrotic kidney shrank in size. Conclusion: Spontaneous perinephric urinoma formation due to High pressure chronic retention was a blessing in disguise for the patient. It saved the affected kidney from getting knocked out. The other side hydroureternephrotic kidney suffered anatomical and functional loss.

Sutureless Technique in Robot-Assisted Partial Nephrectomy

Introduction and Objectives: Bleeding is one of the most unfavorable postoperative complications of partial nephrectomy. It is generally accepted that renorrhaphy is necessary for hemostasis because conventional coagulation is uncertain for hemostasis of renal tumor bed. In soft coagulation mode, the output voltage is regulated <190 V and generates Joule heat without producing sparks that cause tissue carbonization. Carbonized tissue sometimes drops off and it leads to bleeding; however, protein degeneration caused by Joule heat is durable. We introduce our minimally invasive sutureless technique using soft coagulation in robot-assisted partial nephrectomy (RAPN). Materials and Methods: We performed RAPN for 76 consecutive patients with cT1 renal tumor from December 2014 to March 2019. We utilize VIO 300D (ERBE, Germany) for hemostasis of renal tumor bed. The device was set in a “soft coagulation” mode with a power setting of effect 7 and 80 W. In each case, the renal artery was clamped without cooling. During tumor excision, the assistant used a suction/irrigator and a monopolar electrocautery coagulating renal tissue concurrently with the resection of tumor. The renal artery was unclamped after the bleeding was controlled using soft coagulation (early unclamping). After unclamping, additional coagulation was done until complete hemostasis was gained. We did not suture the renal parenchyma when sufficient hemostasis was achieved. The renal artery was reclamped if there was an arterial bleeding and additional coagulation was done. Results: Twenty-four out of 76 cases underwent RAPN by complete sutureless technique that was carried out with neither suture nor renorrhaphy. There was no case with >10 points of R.E.N.A.L nephrometry score, 6 cases were with scores between 7 and 9 points, and 18 cases were with score <6 points. The median age was 65 (39–85) years and the median body mass index was 24.6 kg/m2 (19.3–31.8). The median console time was 106 minutes (71–169) and the median estimated blood loss was 21 mL (0–250 mL). The median tumor size was 2.3 cm (1.1–4.0 cm) and the median warm ischemic time was 9.0 minutes (6.0–29.1 minutes). All cases had negative surgical margins. The median rate of change in estimated glomerular filtration rate was −3.9% (−22.7% to 24.4%) 1 month postoperatively. Clavien–Dindo Grade IIIa urinoma occurred in two patients and postoperative bleeding was not observed in all cases. In the first case of urinoma, no obvious opening of collecting system was observed during the surgery for deep endophytic 31 mm tumor. To assure whether there is leakage, retrograde pyelography was performed after wound closure. Minor leakage from renal calix was found and ureteral stent was positioned. Urinoma of the second patient was found with the stricture of ureteropelvic junction in 6 months after partial nephrectomy. The effect of soft coagulation might have been conducted because there was only a couple of millimeters between the ureteropelvic junction and the tumor bed. Ureteral stent was also positioned for the patient. Conclusion: Soft coagulation is an effective technology for tissue hemostasis. Sutureless hemostasis together with early unclamping is a safe and feasible minimally invasive technique for RAPN. No competing financial interests exist. Runtime of video: 4 mins 5 secs

An unusual consequence of an usual condition: Spontaneous psoas urinoma in a case of urinary tract obstruction

Urinoma and urine leaks can occur at any level from the calyx to the urethra. An urinoma is an encapsulated collection of urine in any confined space or may present as ascites. Urinoma can occur due to multiple causes involving two broad categories-nonobstructive and obstructive. We present a rare case of urinoma in the iliopsoas compartment in a case of urinary tract obstruction due to ureteric calculus. Though, urinomas in various compartments including the iliopsoas are a relatively common occurrence due to iatrogenic trauma like pelvic, gynecological, retroperitoneal and gynecologic surgeries; obstructive causes including ureteric calculi are rare and even rarely reported. Timely recognition and treatment of this uncommon condition is important to avoid complications like abscess formation and electrolyte imbalances.

Zystische abdominale Raumforderung als Komplikation von posterioren Harnröhrenklappen

A case of urinoma with posterior urethral valves and its management is presented. Diagnostic investigations and therapy strategies are discussed. Though rare, this possibility should be considered in the differential diagnosis of neonates presenting with rapidly expanding cystic masses in the abdomen. Early diagnosis and management are the most important prognostic factors that ensure a good outcome in such cases.

Urinoma por iatrogenia ureteral

We present one case of urinoma after gynecologic surgery and the surgical repair. 46-year-old woman referred for urologic consultation for flank pain after hysterectomy. CT scan showed the existence of an urinoma with the ureter included in the radiological lesion. Early treatment after diagnosis with end-to-end anastomosis solved the problem.

Ureteral injuries during gynecological surgery.

The purpose of this study was to review the cases of ureteric injuries during major pelvic surgery that occurred in our department over the last 15 years, in relation to possible predisposing factors and patient management according to the type of injury. From 5,122 major gynecologic operations we found 18 cases of ureteric injury, including 4 cases of urinoma. Parameters that were examined included the indication for surgery and the type of operation, coexisting pathological conditions, the position of and the delay in recognition of the ureteric damage. The incidence of ureteric injury was 0.35%. The time of recognition of injury in 9 cases was during primary surgery and end-to-end anastomosis was performed, whereas in the other 9 cases the injury was recognized after surgery and repair of the ureter was performed, with reimplantation into the bladder in 4 cases and end-to-end anastomosis in 5. Action to prevent the development of iatrogenic ureteral injury must be taken in advance, and the management of ureteric injuries could be improved with prompt recognition and repair by a skilled surgeon.