Urinoma Formation Research Articles

Devastating complication due to rupture of obstructive perinephric urinoma with secondary pyonephrosis necessitating nephrectomy of nonfunctional kidney in a child

Rupture of the pelvicalyceal urinary collecting system causing perirenal and retroperitoneal extravasation of the urine and subsequent mass with secondary infection is a rare complication of ureteral-obstructing calculi. We report a rare case of calyceal rupture with urinoma formation in a child presenting with acute abdomen and nonremitting fever due to secondary pyonephrosis. The retroperitoneal mass on abdomen sonography was confirmed as urinoma communicating with the upper ureter on computed tomography (CT). Gross anatomical observation during surgical intervention revealed extensive pyonephrosis with adhesions involving the adjacent intestinal loop. In addition to complete resection and removal of urinoma, nephrectomy of nonfunctioning right kidney was performed. Patient was discharged after an uneventful postoperative period of 7 days.

Simultaneous laparoscopic management of ureteropelvic junction obstruction and renal lithiasis: the combined experience of two academic centers and review of the literature.

IntroductionApproximately one out of five patients with ureteropelvic junction obstruction (UPJO) present lithiasis in the same setting. We present our outcomes of simultaneous laparoscopic management of UPJO and pelvic or calyceal lithiasis and review the current literature.MethodsThirteen patients, with a mean age of 42.8±13.3 years were diagnosed with UPJO and pelvic or calyceal lithiasis. All patients were subjected to laparoscopic dismembered Hynes–Anderson pyeloplasty along with removal of single or multiple stones, using a combination of laparoscopic graspers, irrigation, and flexible nephroscopy with nitinol baskets.ResultsThe mean operative time was 218.8±66 minutes. In two cases, transposition of the ureter due to crossing vessels was performed. The mean diameter of the largest stone was 0.87±0.25 cm and the mean number of stones retrieved was 8.2 (1–32). Eleven out of 13 patients (84.6%) were rendered stone-free. Complications included prolonged urine output from the drain in one case (Clavien grade I) and urinoma formation requiring drainage in another case (Clavien grade IIIa). The mean postoperative follow-up was 30.2 (7–51) months. No patient has experienced stone or UPJO recurrence.ConclusionLaparoscopy for the management of UPJO along with renal stone removal seems a very appealing treatment, with all the advantages of minimally invasive surgery. Concomitant renal stones do not affect the outcome of laparoscopic pyeloplasty, at least in the midterm. According to our results and the latest literature data, we advocate laparoscopic management as the treatment of choice for these cases.

Pyeloplasty in children by lumbotomy approach using infant feeding tube as single stent

The objective of this study was to assess the outcome in children who had undergone pyeloplasty by lumbotomy approach using infant feeding tube (IFT; 5 Fr) as a single stent. During January 2000 and December 2010, 134 pyeloplasty were performed by the lumbotomy approach. The procedure involves single layer anastomosis at pelvi-ureteric junction using vicryl 5-0/6-0 (reduction of pelvis if required). An IFT 5 Fr with multiple holes used as a single stent to serve as nephrostomy and as transanastomotic stent also. There were 109 males and 25 females with M: F ratio of 4.3:1. Left-side pelvi-ureteric junction obstruction (PUJO) was seen in 117 (87.3%) while right side PUJO in 17 (12.7%). Mean age of presentation was 52.7 months (range 9-120 months). Postoperative complications included infection 2 (1.5%), urinoma formation 1 (0.7%), urine leak 3 (2.2%), non drainage 2 (1.5%), accidental removal of the stent 2 (1.5%). Follow-up scan done at 3 and 9 months showed improved drainage in 124 (92.5%), preserved renal function in 129 (96.2%) cases. Overall success rate 97.5%. Transanastomotic stent using IFT not only provide an effective drainage but also avoid the complications associated with double-J stents and nephrostomies, with the added benefit of being cheaper and availability.

Single-incision (with multi-input single-port) laparoscopic colorectal procedures: Early results.

Single incision laparoscopic surgery (SILS) is a "scar-less" new surgical technique which has been gaining popularity over recent years. In comparison to conventional multiport laparoscopic surgery, SILS is introduced as a less invasive method. This technique has also been applied to colorectal surgery. The aim of the presenting study is to investigate the applicability of SILS and report short term results. We evaluated prospectively collected data of 24 patients who had been operated with "Single Incision Laparoscopic Colon Resection (SILCR)" in our clinic between June 2011-June 2013. Informed consent was obtained from all patients before surgery. Patient data such as ASA and BMI values, need for additional surgery, tumors, number of lymph nodes resected, length of hospital stay, length of surgery, timing of flatus, time to start oral feeding and complications were recorded. SILCR was performed in 24 patients. In 13 patients, SILCR was performed for cancer treatment. There was no need for extra ports, conversion to open surgery and stoma creation was also not necessary. Drain was placed in 4 patients. Overall complication rate was 12.5%. The mean number of lymph nodes in 13 patients who underwent SILCR for tumor was found to be 23 (14-33). The mean operative time and length of hospital stay was 177 minutes (110-363) and 5.35 days (4-11) respectively. Anastomotic leakage was not seen in any of the patients. In one patient, urinoma formation due to ureteral leakage was seen which resulted from thermal injury. When we compare other series with almost the same number of patients' reported SILS results in the literature, we believe that we could draw conclusions from our data. SILS appears to have comparable results to conventional multiport laparoscopic surgery in the hands of experienced surgeons. It seems advantegous as it can be done with conventional laparoscopic instruments in a "scar-less" manner. Prospective randomized trials are necessary to define the benefits of one procedure over the other.

Partial Lower Pole Necrosis of Left Kidney After Therapeutic Embolization With Infected Urinoma and Hematoma Formation in a Patient With Lupus Nephritis

Partial Lower Pole Necrosis of Left Kidney After Therapeutic Embolization With Infected Urinoma and Hematoma Formation in a Patient With Lupus Nephritis

Imaging in renal trauma

Renal injuries are classified, based on the American Association for the Surgery of Trauma classification, in to five grades of injury. Several imaging modalities have been available for assessing the grade of renal injury, each with their usefulness and limitations. Currently, plain radiographs and intravenous urography have no role in the evaluation of patients with suspected renal injury. Ultrasonography (USG) has a limited role in evaluating patients with suspected retroperitoneal injury; however, it plays an important role during follow up in patients with urinoma formation. USG helps to monitor the size of a urinoma and also for the drainage procedure. The role of selective renal arteriography is mainly limited to an interventional purpose rather than for diagnostic utility. Retrograde pyelography is useful in assessing ureteral and renal pelvis integrity in suspected ureteropelvic junction injury and for an interventional purpose, like placing a stent across the site of ureteric injury. Magnetic resonance imaging has no role in acute renal injuries. Multidetector computed tomography is the modality of choice in the evaluation of renal injuries. It is also useful in evaluating traumatic injuries to kidneys with preexisting abnormalities and can help to define the extent of penetrating injuries in patients with stab wounds in the flank region. The combination of imaging findings along with clinical information is important in the management of the individual patient. This article will describe a spectrum of renal injuries encountered in a trauma setting.

Inferior Vena Cava Filter Penetration Resulting in Renal Pelvis Rupture With Urinoma Formation

Inferior vena cava (IVC) filter penetration is common and most often asymptomatic. However, penetration may potentially result in a variety of complications, including aortic trauma and small bowel perforation. Described is a case of IVC filter penetration resulting in renal pelvis perforation with urinoma formation.

Bilateral ureteral complete obstruction with huge spontaneous urinoma formation in a patient with advanced bladder cancer

Spontaneous rupture of the collecting system with extravasation of urine and urinoma formation is usually associated with urinary tract obstruction by a ureteral calculus. Tumor growth is an extremely rare cause of urinary extravasation. Here we report a case of bilateral obstructive uropathy with a huge spontaneous left retroperitoneal urinoma caused by advanced infiltrative transitional cell carcinoma of the urinary bladder. The point of leakage was located in the left renal pelvis. The urinary leakage ceased after percutaneous nephrostomy drainage, and the patient subsequently underwent radical cystoprostatectomy. Histopathology revealed a high-grade urothelial carcinoma of the urinary bladder with pelvic lymph node metastasis. The patient refused any adjuvant treatment and expired 6 months after the operation from disseminated metastasis from bladder cancer.

The impact of perinatal urinoma formation on renal function: our experience and review of the literature

A urinoma is a fluid mass consisting of extravasated urine in the perirenal space. Its impact on renal function was analysed. All cases of prenatal and neonatal urinoma reported in the literature were analysed as well as two cases recently observed in our department. A review of all prenatally diagnosed urinomas revealed 25 cases, for a total of 30 renal units. The cause of obstruction was: lower urinary tract (LUT) obstruction in 16 cases (62.5%), upper urinary tract (UUT) obstruction in seven cases (29.5%) and unknown in two cases (8%). A preserved renal function was found in only 30% of all cases. Furthermore, prognosis for renal function was better in posterior urethral valve (PUV) patients than in uretero-pelvic junction obstruction (UPJO) patients. In addition, we analysed 35 published cases of urinoma with a neonatal onset, without prenatal diagnosis, and secondary to LUT obstruction in 27 cases (77%), UUT obstruction in seven cases (20%), while the underlying cause was unknown in one cases (3%). A preserved renal function was observed in 84% of cases with UUT obstruction and in 80% of cases presenting a LUT obstruction. Prognosis concerning renal function seems to be mainly related to two factors: age at presentation and underlying diagnosis. Decompression of the urinary tract by urine extravasation produces the best results in terms of preservation of the renal function in LUT obstruction (75% in prenatal and 84% in postnatal cases); UUT obstruction however is associated with a good prognosis in the neonatal period (80% of preserved renal function) but with a severe impairment (only 20% of preserved renal function) in prenatally detected cases.

Thulium Laser Laparoscopic Partial Nephrectomy Without Renal Hilar Control in a Porcine Model

Objective Laparoscopic partial nephrectomy is a technically challenging procedure. The most important step is to achieve hemostasis during parenchymal resection. We evaluated the feasibility of thulium:yttrium-aluminum-garnet (Th:YAG) laser partial nephrectomy in a porcine model. Materials and Methods We performed bilateral transperitoneal laparoscopic partial nephrectomies with a 600 μm end-firing laser fiber and a 70 W Th:YAG laser setting in five pigs. Perioperative data including operative time, laser time, estimated blood loss and serum creatinine before and after surgery were collected. Ex vivo retrograde pyelography was performed to detect collecting system leakage after specimen removal. Results Laser resection and hemostasis were successfully accomplished in all cases, and no perioperative complications occurred. Mean estimated blood loss was 50 mL. Mean laser time was 20 minutes. Mean resected renal mass was 25% of total kidney mass. After 14 and 28 days, exploratory laparotomy found no urinoma formation. Conclusion Laparoscopic partial nephrectomy using Th:YAG laser is a feasible surgical method in the porcine model. Future clinical application is warranted.

Comparison of Holding Strength of Suture Anchors on Human Renal Capsule

The use of surgical clips as suture anchors has made laparoscopic partial nephrectomy (LPN) technically simpler by eliminating the need for intracorporeal knot tying. However, the holding strength of these clips has not been analyzed in the human kidney. Therefore, the safety of utilizing suture anchors is unknown as the potential for clip slippage or renal capsular tears during LPN could result in postoperative complications including hemorrhage and urinoma formation. With the above in mind, we sought to compare the ability of Lapra-Ty clips and Hem-o-lok clips to function as suture anchors on human renal capsule. Fresh human cadaveric kidneys with intact renal capsules were obtained. A Lapra-Ty clip (Ethicon, Cincinnati, OH) or a Hem-o-lok clip (Weck, Raleigh, NC) was secured to a no. 1 Vicryl suture (Ethicon) with and without a knot, as is typically utilized during the performance of LPN. The suture was then placed through the renal capsule and parenchyma and attached to an Imada Mechanical Force Tester (Imada, Northbrook, IL). The amount of force required both to violate the renal capsule and to dislodge the clip was recorded separately. Six Lapra-Ty clips and six Hem-o-lok clips were tested. The mean force in newtons required to violate the renal capsule for the Lapra-Ty group was 7.33 N and for the Hem-o-lok group was 22.08 N (p < 0.001). The mean force required to dislodge the clip from the suture for the Lapra-Ty group was 9.0 N and for the Hem-o-lok group was 3.4 N (p < 0.001). When two Hem-o-lok clips were placed on the suture in series, the mean force required to dislodge the clips was 10.6 N. When compared with Lapra-Ty clips, using two Hem-o-lok clips may provide a more secure and cost-effective method to anchor sutures on human renal capsule when performing LPN.

Retrieval methods for urinary stones

This paper attempts to assess the current status of the various modalities of available treatment for urinary stone disease in the Kerala scenario. A total of 300 patients who attended the stone clinic with urinary stone disease and had stones retrieved by different means were selected for the study. Their clinical symptoms, demographic profile, size, number and position of stones, metabolic profiles, retrieval modalities and end result of treatment in terms of stone clearance were assessed. Instances of failure, incomplete clearance and complication events were noted. Based on the experiences, a flowchart was created for appropriate decision-making in urinary stone management. The modalities of retrieval included nephrectomy, nephrolithotomy, pyelo-nephrolithotomy, extended pyelolithotomy, pyelolithotomy, ureterolithotomy, cystolithotomy, urethrolithotomy, ESWL, PCNL, URS, cystolithotripsy, urethrolithotripsy and spontaneous passage. The clearance rate of stone was maximum in open surgery. The extent of stone clearance by ESWL depended on various factors. PCNL was mostly limited by the difficulties in achieving puncture at the stone site. Availability of a variety of flexible nephroscopes also altered the success rate of the procedure. There were good success rates in pushing stones from the ureter to the pelvis followed by PCNL. In patients who had successful PCNL, postoperative morbidity was significantly reduced in terms of the number of days of hospitalization, time taken for return to work, absence of urinary leak, site infection, urinoma formation and urinary tract infection. URS was performed in many patients and stones retrieved. However, the indication for the procedure remains doubtful as the size of most of the stones thus retrieved was less than 6 mm. These would have passed out spontaneously or with chemotherapeutic support. URS, lithotripsy and basketting were confronted by upward migration of stones to the kidney, requiring further procedures for retrieval. Introduction of double J stents helped in relieving urinary obstruction, particularly in patients presenting with anuria, but retained stents, forgotten stents and failed stone retrieval were common following the procedure. The procedure of URS was simplified by the presence of dilated ureter in spontaneous stone passers or those with distal obstruction and proximal dilatation. It is concluded from the study that open surgery still remains the sheet anchor of treatment of urinary stones in many patients in Kerala. Newer lesser invasive procedures should be ethically selected. Decisions should be patient based, taking into consideration the economic feasibility for the procedure proposed.

Spontaneous renal forniceal rupture due to advanced cervical carcinoma with obstructive uropathy

To report and describe the clinical presentation and outcome of a woman presenting with gross perinephric urinary extravasation (due to spontaneous renal forniceal rupture), secondary to malignant obstructive uropathy caused by advanced cervical carcinoma. To review the etiopathogenesis, approach to diagnosis and management of 'spontaneous renal forniceal rupture. The published English literature (PubMed) was searched for similar cases of 'spontaneous renal forniceal rupture' using the keywords: carcinoma cervix, metastatic carcinoma cervix, renal pelvis rupture, renal fornix rupture, spontaneous renal fornix rupture and urinoma. The diagnosis of renal forniceal rupture with gross urinoma formation secondary to advanced cervical carcinoma was suspected on ultrasound and was subsequently confirmed by a computed tomographic scan of the abdomen. Percutaneous nephrostomy with a pigtail catheter resolved the urinoma. Search results for similar cases yielded several causes of spontaneous renal forniceal rupture, however, only one such case report due to advanced cervical carcinoma was found. To the best of our knowledge, this is the second case of spontaneous renal forniceal rupture secondary to ureteral obstruction caused by advanced cervical carcinoma to be reported in the published English literature. A high clinical index of suspicion is warranted in any patient of advanced cervical carcinoma that presents with sudden uremia or oliguria with flank pain and swelling in order to arrive at an early diagnosis. A decompressive nephrostomy may provide the much needed comfort and succor towards prolonging the life of such unfortunate patients.

COMPARISON OF HOLDING STRENGTH OF SUTURE ANCHORS ON HUMAN RENAL CAPSULE

Abstract Introduction: The use of surgical clips as suture anchors has made laparoscopic partial nephrectomy (LPN) technically simpler by eliminating the need for intracorporeal knot tying. However, the holding strength of these clips has not been analyzed in the human kidney. Therefore, the safety of utilizing suture anchors is unknown as the potential for clip slippage or renal capsular tears during LPN could result in postoperative complications including hemorrhage and urinoma formation. With the above in mind, we sought to compare the ability of Lapra-Ty clips and Hem-o-lok clips to function as suture anchors on human renal capsule. Methods: Fresh human cadaveric kidneys with intact renal capsules were obtained. A Lapra-Ty clip (Ethicon, Cincinnati, OH) or a Hem-o-lok clip (Weck, Raleigh, NC) was secured to a no. 1 Vicryl suture (Ethicon) with and without a knot, as is typically utilized during the performance of LPN. The suture was then placed through the renal capsule and parenchyma and attached to...

123I-Metaiodobenzylguanidine accumulation in a urinoma and cortex of an obstructed kidney after surgical resection of an abdominal neuroblastoma

Surgical ureteric injury is rare and often unsuspected for a long time. We present a child in whom an abdominal neuroblastoma was completely excised, but during surgery the left ureter was transected and anastomosed. One month later, during postoperative disease staging, abnormal (123)I-MIBG accumulation was observed in the left renal cortex and the left side of the abdomen. These findings were consistent with acute total obstruction and urinoma formation and were subsequently confirmed by renography and MRI. Despite treatment efforts, a significant amount of left renal mass and function were lost over the following months. These unusual findings are new additions to the literature regarding potential false-positive interpretations of (123)I-MIBG scans.

Tubeless Percutaneous Nephrolithotomy: Safe Even in Supracostal Access

This study was designed to determine the outcome and safety of tubeless percutaneous nephrolithotomy (PCNL) in the treatment of renal calculi. Between November 2005 and March 2006, 48 patients were randomized to either an 18F Re-entry nephrostomy tube (group 1) or a 6F Double-J stent (group 2). The two groups were well matched for age, sex, stone size, stone laterality, and number of previous renal procedures. All PCNL procedures were performed by the same surgeon. Postoperative visual analog pain scale (VAS) scores at 8 and 24 hours and 14 days after surgery, in-hospital analgesic use, length of hospital stay, success rate, blood transfusion rate, and postoperative complications were compared for the two groups. The mean hospital stays in groups 1 and 2 were 3.1 and 1.6 days, respectively (P = 0.003). The mean VAS scores 8 and 24 hours after surgery were significantly lower in group 2 than in group 1 (P = 0.001). The postoperative analgesic requirement (diclofenac sodium) was significantly higher in group 1 (263 mg) than in group 2 (120 mg; P = 0.02). The rate of blood transfusion in the two groups was similar (P = NS). There was no difference between the groups in VAS scores on postoperative day 14. The number of supracostal accesses was significantly higher in group 2 than in group 1 (P = 0.02). The stone-free rates and the numbers of patients with insignificant residual fragments were similar in the two groups. There was no urine leakage or formation of urinoma in patients with Double-J stents. Tubeless PCNL is safe and effective even after supracostal access and is associated with less postoperative pain and a shorter hospital stay.

Immediate Postoperative Complications of Combined Penetrating Rectal and Bladder Injuries

Combined penetrating trauma involving the rectum and bladder has been associated with increased postoperative morbidity. Specific complications resulting from these injuries include colovesical fistula, urinoma, and abscess formation. A retrospective review of Temple University Hospital trauma database was performed. Patients were categorized by having an isolated rectal (n = 29), isolated bladder (n = 16), or combined injury (n = 24). Records were reviewed for sex, age, site of injury, location of rectal and bladder injuries, operative intervention, fistula formation, urinoma formation, abscess formation, time to urinary catheter removal, length of intensive care unit stay, and length of hospital stay. Patient sex and age did not differ significantly between groups, nor was there a significant difference in location of rectal injury between groups. Presacral drainage was utilized in all patients with extraperitoneal injuries. Fecal diversion was performed in all patients, except two with intraperitoneal rectal injuries. Omental flap interposition between rectal and bladder injuries was utilized in one patient. No significant difference was noted in immediate postoperative complications between groups including fistula, urinoma, and abscess formation. However, all cases of colovesical fistula (n = 2) and urinoma (n = 2) formation were noted in those patients with rectal and posterior bladder injuries. Combined rectal and bladder injuries were not associated with an increase in immediate postoperative complications compared with isolated rectal and bladder injuries. However, postoperative fistula and urinoma formation occurred only in patients with a combined rectal and posterior bladder injury. Consequently, these patients may benefit from omental flap interposition between injuries to decrease fistula and urinoma formation.

Dermatomyositis Associated with Bilateral Ureteral Spontaneous Rupture

Dermatomyositis associated with genitourinary malignancies is not uncommon. However, only a few cases associated with ureteral stricture have been reported, and ureteral rupture is even rarer. A 56-year-old woman with dermatomyositis who had been treated with prednisolone, cyclophosphamide, and azathioprine for 2 months presented with fever, hematuria, and abdominal pain for 2 days. Radiographic imaging revealed bilateral ureteral spontaneous rupture and intraperitoneal urinoma formation. Urine cytology and endourologic examinations showed no evidence of genitourinary malignancy. Ureteral urine leakage was managed successfully by drainage through percutaneous catheter and bilateral double-J ureteral stenting. The stents were removed 9 months later. Follow-up intravenous urography 12 months after ureteral stent placement showed good renal function with left mild hydronephrosis and hydroureter above the previous rupture site. Bilateral ureters were patent and there was no evidence of contrast medium extravasation from either ureter. Diuretic renal scanning also showed bilateral nonmechanical obstruction with left-side mild hydronephrosis without urine extravasation. Dermatomyositis can be complicated with spontaneous ureteral rupture. Conservative management with urinary diversion and stenting is feasible.

A rare complication of lumbar disk surgery: Ureteral avulsion

A 49-year-old woman was admitted to our clinic with high fever, left lumbar pain and a mass at the flank following spinal surgery for disk disease. Complete left ureteral avulsion with urinoma formation was detected and she was treated with ureteroureterostomy. As in this case shows that the possibility of ureteral injury to the ureter during surgery for a disk hernia should be familiar to all neurosurgeons, orthopedic surgeons and urologists. When the diagnosis is made during early postoperative period, good results with preservation of the kidney can be achieved.

Impact of prenatal urinomas in patients with posterior urethral valves and postnatal renal function

Posterior urethral valves (PUV) are a common cause of lower urinary tract obstruction. Renal failure occurs in approximately one third of the cases. It is debated whether urinoma formation is a protective mechanism to reduce pressure-related impairment of renal function. The aim of our study was to determine if urinoma formation is able to preserve renal function on the side of the urinoma. Five male patients diagnosed with posterior urethral valves and uni- or bilateral urinoma formation were reviewed. Renal function was assessed by serum creatinine level at days 4-7 and at two months, in addition to dimercaptosuccinylacid (DMSA) scintigraphy at 4-6 weeks postnatal age. Impaired renal function occurred unilaterally in four patients, two had bilateral urinoma formation, and the other two boys presented with unilateral urinoma, one with preserved renal function ipsilateral to the urinoma and the other on the contralateral side. Urinary ascites was detected in three patients, all underwent antenatal centesis. No association was found between renal function and urinoma formation in patients with PUV.