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Simonini C, Strizek B, Strömer A, Gembruch U, Geipel A. Prenatal diagnosis and outcome of fetal urinomas in relation to the underlying etiology. Prenat Diagn 2024; 44:138-147. [PMID: 37060206 DOI: 10.1002/pd.6355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 03/22/2023] [Accepted: 04/10/2023] [Indexed: 04/16/2023]
Abstract
OBJECTIVE Evaluation of course and outcome of pregnancies with prenatally diagnosed fetal urinoma in a single center over a 20-year period. METHODS Retrospective study including all prenatally suspected or diagnosed fetal urinomas. Cases were analyzed by ultrasound findings during pregnancy, comparing urinomas caused by lower urinary tract obstruction (LUTO) and ureteropelvic or ureterovesical junction obstruction (UPJO/UVJO). Course of pregnancy and outcomes were compared according to the underlying etiology. RESULTS 87 cases of fetal urinomas were identified between 2002 and 2022. The underlying etiology was LUTO in 56.3% and UPJO/UVJO in 43.7%. Complications mainly included oligo- or anhydramnios, thoracic hypoplasia as well as associated renal abnormalities. Postnatally, loss of function (LOF) in kidneys affected by urinomas was seen in 78.6% of children overall, but significantly more often in cases of UPJO/UVJO than in LUTO (86.2% vs. 70.2%, p < 0.05). CONCLUSION Association of prenatal urinoma and postnatal LOF of the affected kidney is high, especially in cases caused by UPJO/UVJO. In survivors with urinoma caused by UPJO/UVJO, the general prognosis is excellent if the contralateral kidney was normal. In survivors with urinomas caused by LUTO, long-term prognosis depends on postnatal renal and pulmonary function.
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Affiliation(s)
- Corinna Simonini
- Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Bonn, Germany
| | - Brigitte Strizek
- Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Bonn, Germany
| | - Annika Strömer
- Department of Medical Biometrics, Informatics, and Epidemiology, University Hospital Bonn, Bonn, Germany
| | - Ulrich Gembruch
- Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Bonn, Germany
| | - Annegret Geipel
- Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Bonn, Germany
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Dorosiev E, Minova G, Mladenov B, Pelov T, Peev S. Neonatal urinoma associated with ascites in a newborn with a solitary kidney. Folia Med (Plovdiv) 2022; 64:998-1002. [PMID: 36876553 DOI: 10.3897/folmed.64.e69787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Accepted: 09/20/2021] [Indexed: 01/01/2023] Open
Abstract
Fetal urinomas are often diagnosed in prenatal ultrasonography. The etiology is usually an obstructive uropathy leading to hydronephrosis and increased intrarenal pressure putting future kidney function at risk. Rupture of pyelocaliceal system in such cases may lead to retroperitoneal urinoma or urinary ascites, sepsis, uraemia, and acute renal failure. On the other hand, this may serve as "pop-off valve" mechanism decreasing intrarenal pressure and protecting from definitive kidney function loss. We present a case of a newborn girl with a retroperitoneal urinoma, ascites, uraemia, and obstruction of a solitary right kidney, which was successfully treated minimally invasively through peritoneal and retroperitoneal drainage and intubation of the right ureter with a DJ stent shortly after birth.
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Affiliation(s)
- Emil Dorosiev
- Clinic of Urology, NI Pirogov UMHATEM, Sofia, Bulgaria
| | | | | | - Teofil Pelov
- Clinic of Urology, NI Pirogov UMHATEM, Sofia, Bulgaria
| | - Stoyan Peev
- Clinic of Urology, NI Pirogov UMHATEM, Sofia, Bulgaria
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Chan KJ, Singaravel S, Westerhout CJ, Choo YM, Kamar AA. Urinoma Causing Abdominal Distension and Respiratory Distress in a Newborn. J Pediatr 2022; 245:239-240. [PMID: 35216973 DOI: 10.1016/j.jpeds.2022.02.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 02/17/2022] [Indexed: 11/15/2022]
Affiliation(s)
- Kok Joo Chan
- Neonatal Intensive Care Unit, Department of Pediatrics
| | | | | | - Yao Mun Choo
- Neonatal Intensive Care Unit, Department of Pediatrics, University of Malaya Medical Center, Kuala Lumpur, Malaysia
| | - Azanna Ahmad Kamar
- Neonatal Intensive Care Unit, Department of Pediatrics, University of Malaya Medical Center, Kuala Lumpur, Malaysia
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Kozlova D, Gilboa Y, Sade-Zalts C, Gielchinsky Y, Shteingart S, Kidron D. Fetal Urinoma Due to Circulatory Disorders in an Umbilical Artery: Case Report. Pediatr Dev Pathol 2021; 24:383-387. [PMID: 33749381 DOI: 10.1177/10935266211002730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Fetal urinoma is defined as an encapsulated accumulation of extravasated urine within the perirenal space or retroperitoneum. It is an uncommon finding in prenatal practice, and the vast majority of known cases are strongly associated with the existence of a urinary obstruction, such as posterior urethral valves, ureteropelvic junction obstruction, or ureterocele. We report a unique case of prenatally detected fetal bladder urinoma that occurred in the absence of an apparent obstructive uropathy, but was associated with extensive ischemic necrosis and calcifications of adjacent bladder wall, coexistent with signs of vascular supply decompensation.
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Affiliation(s)
- Daria Kozlova
- Department of Pathology, Rabin Medical Center, Beilinson Campus, Petah Tikva, Israel
| | - Yinon Gilboa
- Sackler School of Medicine, Tel Aviv University, Tel-Aviv, Israel.,Helen Schneider Hospital for Women, Rabin Medical Center, Beilinson Campus, Petach-Tikva, Israel
| | - Chen Sade-Zalts
- Department of Pathology, Rabin Medical Center, Beilinson Campus, Petah Tikva, Israel
| | - Yuval Gielchinsky
- Helen Schneider Hospital for Women, Rabin Medical Center, Beilinson Campus, Petach-Tikva, Israel
| | - Shimon Shteingart
- Department of Nursing, Jerusalem College of Technology, Jerusalem, Israel
| | - Debora Kidron
- Sackler School of Medicine, Tel Aviv University, Tel-Aviv, Israel.,Pathology Department, Meir Hospital, Kfar Saba, Israel
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Muthee BW, Bray HJ. Approach to the postnatal sonographic evaluation of prenatally detected abdominopelvic cysts. Ultrasonography 2021; 41:53-73. [PMID: 34344138 PMCID: PMC8696132 DOI: 10.14366/usg.21070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 05/22/2021] [Indexed: 11/10/2022] Open
Abstract
Prenatally detected abdominal and pelvic masses are commonly cystic in morphology and usually seen on mid-trimester sonography. Sonography is the favored imaging modality for the postnatal evaluation of these lesions in newborns, given its availability, low cost, lack of ionizing radiation, lack of sedation, and high spatial resolution in small patients. The differential diagnosis of abdominopelvic cystic masses in newborns is broad given that they can arise from many organs and may have overlapping features on imaging. This article illustrates an approach to the postnatal sonographic evaluation of prenatally detected cystic abdominal and pelvic masses based on their anatomic location and distinctive sonographic characteristics, which can aid in an accurate diagnosis and guide appropriate management.
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Affiliation(s)
- Bernadette Wambui Muthee
- Department of Radiology, British Columbia Children's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Heather J Bray
- Department of Radiology, British Columbia Children's Hospital, University of British Columbia, Vancouver, BC, Canada
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Prenatal extravasation of urine seems to preserve renal function in boys with posterior urethral valves. J Pediatr Urol 2019; 15:241.e1-241.e7. [PMID: 30982696 DOI: 10.1016/j.jpurol.2019.02.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 12/11/2018] [Accepted: 02/20/2019] [Indexed: 01/08/2023]
Abstract
INTRODUCTION A posterior urethral valve (PUV) may lead to extravasation of urine, resulting in prenatal ascites and/or perirenal urinoma. Extravasation has been presumed to act as a pop-off mechanism, preserving renal function, but previous reports addressing this presumption have been inconclusive. AIM OF STUDY The present study compares renal function in patients with PUV with and without extravasation. MATERIAL AND METHODS Sixty boys with a confirmed diagnosis of PUV as neonates (gestational age [GA]<44 weeks) throughout 2001-2016 were included. Clinical data were collected from medical records. Renal function was assessed by nadir plasma creatinine, creatinine at the last follow-up, and glomerular filtration rate (GFR) at the last follow-up. The GFR was estimated using the Schwartz formula. Renal function was classified according to the kidney disease: improving global outcomes (KDIGO) guidelines' grades of chronic kidney disease (CKD). Glomerular filtration rate > 90 ml/min/1.73m2 at the last follow-up was classified as normal renal function. RESULTS Twelve patients (20%) had ascites and/or urinoma, and 48 (80%) did not. GA and birth weight were not different in patients with and without extravasation. PUV was suspected from prenatal ultrasound findings in 66.7% of the patients in both groups. Median nadir creatinine was 21 (range, 11-33) μmol/L in boys with ascites/urinoma, and all values were within the age-adjusted reference values. Nadir creatinine was 23 (14-199) μmol/L in boys without extravasation, and it was above the normal range in 14 boys. The incidence of elevated nadir creatinine was significantly different in the two groups (p < 0.025). One of the 12 patients with extravasation developed chronic renal failure (CKD 3). In the group of 48 patients without extravasation, 20 (42%) had chronic renal failure grade 2-5, and among these, 5 patients have had a renal transplant (CKD grade 5). The prevalence of CKD grade 2-5 was statistically different in the two groups (p = 0.03). These findings are presented in the summary figure. CONCLUSION Extravasation of urine was found in 12 of 60 (20%) boys with PUV. These patients had significantly lower prevalence of CKD at the last follow-up than patients without extravasation. This finding is important in prenatal counseling. It also indicates that prenatal decompression of the bladder and upper tract is beneficial in patients with PUV, which is relevant to the discussion of prenatal intervention in these fetuses.
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Maher J, Gao M, Kelly R, Hutton K, Kodeih H, Schlabritz-Loutsevitch N. Prenatal Diagnosis of a Urinoma and Dilated Azygous Vein. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2018; 37:1049-1051. [PMID: 29027692 DOI: 10.1002/jum.14425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2017] [Revised: 07/03/2017] [Accepted: 07/11/2017] [Indexed: 06/07/2023]
Affiliation(s)
- James Maher
- Department of Obstetrics and Gynecology, Texas Tech University Health Science Center School of Medicine at the Permian Basin, Odessa, Texas, USA
| | - Mamie Gao
- Department of Obstetrics and Gynecology, Texas Tech University Health Science Center School of Medicine at the Permian Basin, Odessa, Texas, USA
| | - Randall Kelly
- Department of Obstetrics and Gynecology, Texas Tech University Health Science Center School of Medicine at the Permian Basin, Odessa, Texas, USA
| | - Kathryn Hutton
- Department of Obstetrics and Gynecology, Texas Tech University Health Science Center School of Medicine at the Permian Basin, Odessa, Texas, USA
| | - Hanna Kodeih
- Department of Obstetrics and Gynecology, Texas Tech University Health Science Center School of Medicine at the Permian Basin, Odessa, Texas, USA
| | - Natalia Schlabritz-Loutsevitch
- Department of Obstetrics and Gynecology, Texas Tech University Health Science Center School of Medicine at the Permian Basin, Odessa, Texas, USA
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Ultrasound follow-up of an unusual giant urinoma in a newborn. J Ultrasound 2018; 21:65-68. [PMID: 29374393 DOI: 10.1007/s40477-016-0224-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Accepted: 11/16/2016] [Indexed: 10/20/2022] Open
Abstract
Urinoma, defined as an encapsulation of urine caused by urine extravasation into the perirenal space either through rupture of a calyceal fornix or a tear in the renal parenchyma, is an uncommon finding in prenatal diagnosis and the neonatal period. Urinoma can be associated with any urinary tract obstruction, or, as reported in several published cases, related to vesicoureteral reflux, kidney dysplasia, or complication arising during amniocentesis. We report on a newborn with a perinatal urinoma, with initial slight corpusculated fluid associated with nonobstructive and nonrefluxing megaureter, and no signs of kidney dysplasia. Close sonography follow-up of the urinoma allowed complex differential diagnoses, including cystic, septated, and solid perirenal masses, due to dissimilar and peculiar ultrasound images during urinoma evolution stages.
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Zhang H, Yang H, Sun Y, Fan L, Zhang X. Prenatal drainage of fetal urinoma with polyhydramnios: a case report and literature review. J Matern Fetal Neonatal Med 2017; 31:264-266. [PMID: 28076981 DOI: 10.1080/14767058.2017.1281242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The appearance of fetal urinoma is rare in prenatal care, especially when associated with polyhydramnions. Many previous reports have concluded that the visualization of a prenatal urinoma is probably a sign of underlying renal dysplasia or poor function. Thus, the management of the reported cases, conservative treatment or uniroma drainage, has not been unified. In this paper, we present two cases of prenatally detected urinoma with prenatal drainage to improve the prognosis.
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Affiliation(s)
- Huijing Zhang
- a Department of Obstetrics and Gynecology , Peking University First Hospital , Beijing , China
| | - Huixia Yang
- a Department of Obstetrics and Gynecology , Peking University First Hospital , Beijing , China
| | - Yu Sun
- a Department of Obstetrics and Gynecology , Peking University First Hospital , Beijing , China
| | - Lixin Fan
- a Department of Obstetrics and Gynecology , Peking University First Hospital , Beijing , China
| | - Xiaoxiao Zhang
- a Department of Obstetrics and Gynecology , Peking University First Hospital , Beijing , China
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Gómez Huertas M, Culiañez Casas M, Molina García F, Carrillo Badillo M, Pastor Pons E. Complementary role of magnetic resonance imaging in the study of the fetal urinary system. RADIOLOGIA 2016. [DOI: 10.1016/j.rxeng.2016.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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12
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Gómez Huertas M, Culiañez Casas M, Molina García F, Carrillo Badillo M, Pastor Pons E. Papel complementario de la resonancia magnética en el estudio del sistema urinario fetal. RADIOLOGIA 2016; 58:101-10. [DOI: 10.1016/j.rx.2015.12.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2015] [Revised: 12/11/2015] [Accepted: 12/16/2015] [Indexed: 12/11/2022]
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Abstract
Fetal urinomas are a rare but important sonographic finding. Urinomas are peri‐renal collections of urine, formed after the rupture of the kidney secondary to an underlying urinary tract obstruction or trauma. Diagnosis antenatally is important for ongoing monitoring and postnatal follow up as their presence may indicate reduced or absent kidney function in the affected kidney.
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Affiliation(s)
- Danica Vress
- Fetal Medicine Unit Centenary Women's and Children's Hospital Canberra Australian Capital Territory Australia
| | - Meiri Robertson
- Fetal Medicine Unit Centenary Women's and Children's Hospital Canberra Australian Capital Territory Australia
| | - Debra Paoletti
- Fetal Medicine Unit Centenary Women's and Children's Hospital Canberra Australian Capital Territory Australia
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Epelman M, Daneman A, Donnelly LF, Averill LW, Chauvin NA. Neonatal Imaging Evaluation of Common Prenatally Diagnosed Genitourinary Abnormalities. Semin Ultrasound CT MR 2014; 35:528-54. [DOI: 10.1053/j.sult.2014.07.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Abstract
This article summarizes the most recent literature regarding congenital lower urinary tract obstruction in the fetus and newborn. Lower urinary tract obstruction is a heterogeneous group of rare diagnoses that have significant potential for in utero mortality and long-term morbidity in survivors. The diagnosis and management of the most common causes are reviewed. In addition, the current state of prenatal intervention for congenital lower urinary tract obstruction is discussed.
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Affiliation(s)
- Douglass B Clayton
- Division of Pediatric Urologic Surgery, Department of Urologic Surgery, Monroe Carrel Jr. Children's Hospital, 2200 Children's Way, 4102 DOT, Nashville, TN 37232, USA.
| | - John W Brock
- Division of Pediatric Urologic Surgery, Department of Urologic Surgery, Monroe Carrel Jr. Children's Hospital, 2200 Children's Way, 4102 DOT, Nashville, TN 37232, USA
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