Prenatal diagnosis and outcome of fetal urinomas in relation to the underlying etiology.

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.

Late diagnosis of ureteral injury from anterior lumbar spine interbody fusion surgery: Case report and literature review.

BACKGROUND: Anterior Lumbosacral Interbody Fusion (ALIF) is a type of back surgery with the advantages of direct access to the spinal interbody space and the potential lessening morbidity related to posterior approaches. PURPOSE: To describe a rare case of left ureteral lesion from ALIF surgery diagnosed 4 months after the procedure. CASE DESCRIPTION: A 37-year-old Caucasian man with a long history of painful post-traumatic spondylolisthesis and degenerative L5-S1 disc disease underwent a retroperitoneal anterior L5-S1 discectomy, insertion of an interbody tantallium cage, and placement of a pyramid titanium plate fixed with screws. Four months later, due to recurrent left lumbar pain and mild renal failure, a CT scan was performed showing left hydronephrosis with a homolateral urinoma of 17 cm in diameter. A left nephrostomy was placed and the nephrostography detected a filiform leakage at L5-S1 level in communication with the urinoma. The patient underwent laparoscopic urinoma drainage, distal left ureterectomy, and Casati-Boari flap ureterocystoneostomy with ureteral double J stent placement. The stent was held for six weeks and, 1 month later, the control ultrasound scan was negative for hydronephrosis, the creatinine level had normalized and the patient was asymptomatic. CONCLUSION: Ureteral lesion from ALIF surgery is a very rare event. Spinal surgeons should be more awareness regarding the susceptibility of ureteral injuries along with the clinical presentation, diagnostic work-up, and management options for this kind of complication.

Perinephric transplant fluid collection approach and management.

Renal transplant is the treatment of choice for end-stage renal disease. Perirenal fluid collections are a common surgical complication postrenal transplant that may lead to early graft loss, considerable morbidity, and excess financial loss, if not diagnosed and managed early. The causes of posttransplant fluid collections are urinary leak, lymphocele, hematoma, and seroma, which can be further complicated by abscess formation if becomes infected. Urine leak is considered the most common urological complication postrenal transplant. Diagnosis can be made by biochemical analysis of the fluid drainage with the simultaneous comparison to that of serum. Radiological imaging is also essential for confirming the diagnosis of urinary leak that may not necessarily identify the site of the leak. The management of urinary leak is usually surgical unless the leak is small. The choice of surgery depends on the location of the leak, the vascularization of the involved ureter, and the presence of any complications caused by the leak. This article reviews the differential diagnoses of perirenal fluid collections in postrenal transplant period and focuses on the clinical assessment of urinoma and management options according to the latest evidence-based medicine.

Diagnosis and management of urinary extravasation after high-grade renal trauma.

Renal trauma research has historically focused on parenchymal injuries and the risk of bleeding. However, much less is known about the diagnosis and optimal management of urinary extravasation, which complicates ~30% of high-grade renal injuries. Immediate or delayed ureteral stenting is the most common procedure used to treat collecting system injuries when intervention is needed. However, the lack of evidence-based guidelines leaves the diagnosis and management of urinary extravasation largely dependent upon physicians' experience, initial and follow-up imaging protocols, and the definitions used for grading the injuries. The knowledge gaps in the management of urinary extravasation that need to be addressed include the timing of excretory-phase CT imaging, patterns of clinically significant urinary extravasation, predictors of complications when urinary extravasation occurs, protocols for obtaining and interpreting follow-up imaging, and the role of ureteral stenting and other interventions in management. To improve the management of urinary extravasation after high-grade renal trauma, large, multi-institutional prospective trails assessing different diagnostic and therapeutic protocols are needed.

Bilateral Spontaneous Urinoma in a Cyanotic Child.

BACKGROUND: Urinoma is an encapsulated collection of extravasated urine, secondary to trauma or obstructive uropathy. Spontaneous bilateral urinoma is rare. CASE CHARACTERISTICS: 7-year-old boy with cyanotic heart disease and fever of unknown origin. OBESERVATION: The ultrasound abdomen and CT abdomen revealed bilateral spontaneous urinoma which was aspirated and was found to be infected. Following intravenous atibiotics the child became afebrile, with subsequent renal scans showing no recurrence. MESSAGE: Hypoxia and consequent polycythemia may be responsible for perinephric leaks leading to Non-traumatic spontaneous urinoma.

[A very unusual pleural presentation]. / Une pleurésie très inhabituelle.

Urinothorax refers to the presence of urine in the pleural space. Urinothorax is an infrequent and underdiagnosed pathology, with few cases reported, and these often suspected only with hindsight. It is usually a transudative pleural effusion. We report a case of urinothorax presenting as a purulent pleural effusion. Management of the urinothorax required antibiotics and surgical unblocking of the urinary tract. Currently, no test is available to confirm the diagnosis. The ratio of serum creatinine/pleural creatinine could suggest the presence of urinothorax but this parameter needs to be validated by complementary studies. Urinothorax should be suspected in the context of pleural effusion occurring after a recent urologic surgery.

The Urinothorax: A Comprehensive Review With Case Series.

Urinothorax is an uncommon thoracic complication of genitourinary (GU) tract disease, which is most frequently caused by obstructive uropathy, but may also occur as a result of iatrogenic or traumatic GU injury. It is underrecognized because of a perceived notion as to the rarity of the diagnosis and the absence of established diagnostic criteria. Urinothorax is typically described as a paucicellular, transudative pleural effusion with a pleural fluid/serum creatinine ratio >1.0. It is the only transudate associated with pleural fluid acidosis (pH < 7.40). When the pleural fluid analysis demonstrates features of a transudate, pH <7.40 and a pleural fluid/serum creatinine ratio >1.0, a confident clinical diagnosis of urinothorax can be established. A technetium 99m renal scan can be considered a confirmatory test in patients who lack the typical pleural fluid analysis features or fail to demonstrate evidence of obstructive uropathy that can be identified via conventional radiographic modalities. Management of a urinothorax requires a multidisciplinary approach with an emphasis on the correction of the underlying GU tract pathology, and once corrected, this often leads to a rapid resolution of the pleural effusion.

An Unusual Presentation in Urinothorax.

Urinothorax is defined as the presence of urine in the pleural cavity. Leakage from the urinary tract can cause urinoma with retroperitoneal urine collection, and secondarily, urinothorax. We report the case of a 35-year-old female who presented with dyspnoea and right-sided chest pain. Chest radiograph revealed a right-sided pleural effusion. The patient had undergone left-sided ovarian cystectomy three months ago, had sustained a left-sided ureteric injury that required ureteric stent placement. Urinothorax was suspected as a consequence of ureteric injury; pleural fluid to serum creatinine ratio was found to be greater than one, confirming the diagnosis.

Transient large urinoma following hysterectomy.

This case report describes the formation of a very large urinoma 1 day after vaginal surgery. A 59-year-old woman was diagnosed with a urinoma measuring 30.5 cm in length, 23 cm in the transverse plane and 12 cm in the anteroposterior dimension on day 1 after a vaginal hysterectomy and prolapse repair surgery. The urinoma resolved completely after trans-abdominal catheter drainage. This case demonstrates that even a large urinoma can initially be managed conservatively. Furthermore, it emphasizes the importance of the early detection and management of urinary tract injuries after vaginal surgery.

A rare aetiology for increased drain output following a robotic-assisted prostatectomy.

Robotic prostatectomies are being performed increasingly, with greater visualisation and improved precision, resulting in fewer postoperative complications. Despite advances in surgical techniques, drain output still remains one of the first signs of potential complications. We present the case of an iatrogenic cause for high drain output postoperatively, in order to highlight the potential problems of the drain itself. A 69-year-old man presented with a pelvic drain output of over 2 L a day as a result of the drain tip being placed at the site of the anastomosis. Here we discuss the rates of the three main causes of increased drain outputs following robotic prostatectomy, as well as highlighting the resulting complications. Overall, this case highlights the potential complications arising from the drain, which could potentially be avoided by either routine evaluation of the drain position postoperatively or by omitting the drain entirely if the anastomosis is performed well.

Enfermedad renal: urinoma. A propósito de un caso / Renal disease: urinoma. Apropos of a case

Objetivo. Ecografía permite diagnosticar y seguir el progreso de las uropatías obstructivas incluyendo la aparición de urinomas. Sujeto y métodos. Presentamos un caso de hidronefrosis diagnosticado en segundo trimestre con evolución posterior a urinoma. Resultados. Paciente de 21,4 semanas de gestación (SG) se realiza ecografía observándose hidronefrosis izquierda grado II. A las 27.5SG se observó una hidronefrosis izquierda con colección líquida de 40×50×30mm retroperitoneal izquierda peri-renal con distorsión de la morfología del riñón desplazado medialmente compatible con urinoma. Conclusiones. La aparición prenatal de un urinoma se asocia a afectación postnatal en diferente grado de la función del riñón afectado (AU)

Objective. Fetal ultrasound enables us to diagnose and follow the progress of obstructive uropathies including the occurrence of fetal urinomas. Subject and methods. We report a case of hydronephrosis diagnosed in the second trimester with evolution urinoma. Results. Patient at 21.4 weeks’ gestation showed in fetal ultrasound a left hydronephrosis grade II. At 27.5w showed a left hydronephrosis with a retroperitoneal fluid collection perirenal 40×50×30mm and distortion of the kidney morphology compatible with urinoma. Conclusions. the prenatal occurrence of an urinoma is often associated with the postnatal absence of function of the involved kidney (AU)

Urinoma prenatal y función renal posnatal / Prenatal urinoma and postnatal renal function

El urinoma es orina extravasada, contenida por la fascia de Geroto; ecográficamente es una imagen econegativa entre el riñón y la fascia renal, sin continuidad con el sistema pielocalicial ni el parénquima. Diagnosticamos un urinoma a las 24 semanas de gestación, que fue regresando y desapareció a la 28 semana; en el control posnatal objetivamos riñón displásico. Revisamos 40 casos, objetivando en un 80,6% de estos una afectación de la función renal ipsolateral. Son factores de mal pronóstico en la función renal posnatal feto femenino, aparición de urinoma en el segundo trimestre, estenosis de la unión ureteropélvica, regresión intraútero y visualización de riñón displásico(AU)

Urinoma consists of extravasated urine contained by Gerota's fascia. On ultrasound examination, this entity appears as an echo-negative image between the kidney and the renal fascia without continuity with the ureteropelvic junction or the renal parenchyma. We diagnosed a urinoma in a woman at 24 weeks of pregnancy, which was totally resorbed and disappeared at 28 weeks of pregnancy; in the postnatal stage, a dysplastic kidney was found. We reviewed 40 cases and found ipsilateral kidney involvement in 80.6% of cases. Poor prognostic factors for postnatal kidney function were female fetus, diagnosis in the second trimester, ureteropelvic junction stenosis, intrauterine resorption and visualization of a dysplastic kidney(AU)

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.

Emphysematous urinoma as a complication of emphysematous pyelitis in a healthy adult male.

Emphysematous pyelitis and urinomas are independently rare conditions. The former is a severe necrotizing infection involving the renal collecting system, the latter an encapsulated collection of urine in the perinephric or paraureteral space. An unusual case of emphysematous urinoma complicating emphysematous pyelitis in a healthy male adult is presented in this study.