Pararenal pseudocyst (urinoma) as complication of percutaneous nephrostomy

[Combined radiologic-urologic procedure for the placement of ureteral stent in a case of bilateral iatrogenic ureteral lesion]

INTRODUCTION

Iatrogenic ureteral lesions are well-known complications of abdominal and pelvic surgery. A combined radiologic-urologic approach might be necessary to repair these lesions.

MATERIALS AND METHODS

A 69-year-old woman underwent bilateral hysteroannessectomy for endometrial cancer. She then became anuric. A CT scan showed multiple urinomas caused by bilateral ureteral lesions. The continuity of the two urinary tracts was restored using ureteral stents in a combined urologic and radiologic procedure.

RESULTS

The patient improved clinically and the renal function returned within normal limits.

CONCLUSIONS

The combined antegrade-retrograde approach is an effective technique to solve iatrogenic ureteral lesions.

Renal cysts and urinomas

Renal cysts are a common imaging finding. Although most cysts never have symptoms, some cause pain, collecting system compression, hematuria, hypertension, and secondary infection. The mere presence of a cyst is not an indication for intervention, but treatment may be indicated in symptomatic patients or those with secondary obstruction. Urinomas generally are a contained collection of urine outside of the normal pathways where urine travels. As such, urinomas can arise anywhere from the upper abdomen down into the low pelvis and have a variety of etiologies. Ureteral obstruction with forniceal rupture and trauma (blunt, penetrating, or iatrogenic) are the most common causes of urinomas. When urinomas arise spontaneously, the likely cause varies with the patient's age. Blunt or penetrating trauma can cause perinephric urinomas by two mechanisms-direct disruption of the pelvis or collecting system or by degeneration of nonviable tissue. These urinomas are often perinephric, but can also occur in a subcapsular location. This review will discuss diagnosis, classification, and treatment of renal cysts and urinomas.

Secondary urinoma mimicking recurrent tumor as a cause of bilateral ureteral obstruction

A case is reported of a previously resected adenocarcinoma of the rectum presenting with recurrent tumor in the pelvis and an abdominal mass that was found to be a large urinoma. Dialysis was discontinued after drainage of the extravasated urine, and the patient's condition became stable. A review of the literature is also discussed.

Percutaneous catheter drainage of post-traumatic urinoma

We report a case that demonstrates that percutaneous catheter drainage may be considered as an alternative to surgical intervention in the treatment of urinomas, especially when there is no persistent ureteral obstruction.

Percutaneous nephrostomy for ureteral obstruction in patients with gynecologic malignancy

Reversible ureteral obstruction is not an infrequent complication of gynecologic malignancy or its treatment. In the past, open nephrostomy has been the standard method of management in such patients. This paper discusses the nonoperative technique of percutaneous nephrostomy which allows placement of either an external nephrostomy tube or an internal ureteral stent under local anesthesia. Six illustrative cases are presented and the indications and technical aspects of the procedure are discussed.