Fetal Urinoma Due to Circulatory Disorders in an Umbilical Artery: Case Report.

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.

Perinephric urinoma following spontaneous renal rupture in the third trimester of pregnancy: a case report and brief review of the literature.

BACKGROUND: Spontaneous formation of urinoma is a rare condition, especially for pregnant women. We report a patient in the third trimester of pregnancy with a spontaneous renal rupture who then develops a urinoma from urine leaking into the perinephric space. CASE PRESENTATION: A 23-year-old primagravida was diagnosed with a spontaneous renal rupture and acute left loin pain accompanied by hematuria when she was 35 weeks pregnant. A sub-capsular perinephric cyst then developed to a size of 319 × 175 × 253 mm, and because of discomfort to the patient, we performed Cesarean section. After a healthy male newborn was delivered, fluid was suctioned from a large perirenal cyst that had an estimated size of 300 × 200 × 300 mm. A percutaneous nephrostomy tube was left in the cyst until CT showed no remaining fluid. In the six-month follow-up, the patient showed no perirenal extravasation according to an ultrasound scan, and the urine analysis and renal function tests were normal. CONCLUSION: Close follow-up should be recommended for the patient who has renal rupture after conservative therapy, especially for pregnant woman. CT or MRI should be considered in addition to utilizing ultrasound in the management of pregnant women who present with urinomas. Percutaneous nephrostomy is suggested as an appropriate treatment for large urinomas.

High Grade Urothelial Carcinoma of Renal Pelvis Presenting as Spontaneous Urinoma.

Perirenal urine extravasation, also known as urinoma, occurs usually after renal trauma. Spontaneous urinoma is a very rare pathology in daily urology practice. The patients with spontaneous urinoma usually present with flank pain, and radiologic imagings confirm the diagnosis. Ultrasonography, intravenous urography, and computed tomography are the radiologic modalites for the diagnosis. We report a case of spontaneous urinoma in a patient with renal pelvic tumor.

Incidental Diagnosis of a Large Retroperitoneal Urine Accumulation (Urinoma) on an 18F-FDG PET/CT Scan Performed for Primary Staging of Urothelial Carcinoma.

F-FDG PET/CT performed for primary staging 3 days after ureteroscopy demonstrated a large, unexpected retroperitoneal urinoma in a 62-year-old man with urothelial carcinoma in the right renal pelvis.

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

INTRODUCTION: A urinoma is a fluid mass consisting of extravasated urine in the perirenal space. Its impact on renal function was analysed. METHODS: All cases of prenatal and neonatal urinoma reported in the literature were analysed as well as two cases recently observed in our department. RESULTS: 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. CONCLUSIONS: 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.

Maternal urinoma during pregnancy.

Urinoma is peripelvic extravasation of urine seen as the squeal of urinary trauma or stones. Little is known about maternal urinoma during pregnancy. A 27-year-old primigravida presented with gradual worsening right flank pain at 21(5/7) weeks of gestation. She denied any past medicosurgical history. Initial work-up revealed cost-vertebral angle tenderness and mild hydronephrosis by ultrasonography. Her symptom worsened and follow-up ultrasonography was performed 48 h later, which showed worsened hydronephrosis with large perinephric fluid collection. A Double-J stent was placed under cystoscopy. After the placement, the patient's symptoms improved quickly. The stent was removed three weeks later. The patient delivered vaginally at 39 weeks of gestation without complication. Maternal urinoma during pregnancy developed in the right side of the kidney in five of six reported cases (83.3%), and all were seen in the second half of pregnancy. All showed flank pain as the initial presentation. Ultrasonography for diagnosis was used in half of the patients. Fifty percent underwent Double-J stent before delivery and 16.7% after delivery. All cases delivered at term and 33.3% underwent cesarean delivery. Maternal urinoma is an important differential diagnosis for flank pain during pregnancy. Double-J stent placement was the main management. Close monitoring of the symptom with serial ultrasonography may be the key for diagnosis.

Diagnóstico prenatal de una masa suprarrenal fetal / Prenatal diagnosis of a fetal adrenal mass

El neuroblastoma es el tumor suprarrenal más frecuente en el feto, generalmente en su variedad quística (benigna). El diagnóstico diferencial hay que realizarlo con la hemorragia suprarrenal, que tiene un pronóstico favorable y una resolución espontánea postparto. La glándula suprarrenal es una estructura muy vascularizada con un tamaño relativo 20 veces superior a la del adulto, por lo que un aumento brusco de la presión intravascular o una agresión hipóxica pueden provocar un sangrado intraglandular. La técnica diagnóstica prenatal de elección es la ecografía. Cuando la hemorragia se produce durante el embarazo se diagnostica habitualmente alrededor de la semana 20 de gestación. Cuando se sospecha una hemorragia suprarrenal se aconseja seguimiento ecográfico en espera de su resolución postnatal. Presentamos el caso de una gestante a la que se le detectó ecográficamente en la semana 20 una tumoración suprarrenal fetal izquierda que fue aumentando de tamaño durante el embarazo. El parto se produjo en la semana 41 y tras el mismo se confirmó la presencia de una tumoración, descartándose adenopatías o metástasis. En el estudio ecográfico al mes de vida se observó una disminución del tamaño tumoral con hiperecogenicidad, por lo que se diagnosticó hemorragia suprarrenal fetal en regresión (AU)

Neuroblastoma, the most common adrenal mass, generally presents as a cystic tumour of benign nature. Differential diagnosis should consider adrenal hemorrhage, condition which carries better prognosis and spontaneous resolution after delivery. Fetal adrenal gland, a vasculari in the gland as a result of high pressure or hypoxic injury. The gold standard method of diagnosis is based on ultrasound. When adrenal bleeding occurs during pregnancy, diagnosis of this condition takes place at around twenty weeks. Then, when adrenal hemorrhage is suspected, conservatory management with follow up scans is advised until spontaneous resolution is reached. A case of twenty week pregnancy in which a growing left adrenal tumour was detected is presented. After delivery, the presence of an isolated tumour not associated with metastasis or lymph nodes was confirmed. Ultrasound follow up one month later showed reduction of size and echogenicity of the tumour which led to the diagnosis of adrenal hemorrhage in regression (AU)