Incidental Diagnosis of Right Renal Subcapsular Urinoma on an 18 F-FDG PET/CT Scan Performed for Staging of Cervical Cancer.

ABSTRACT: A 53-year-old woman with cervical cancer underwent FDG PET/CT staging, which demonstrated an avid cervical mass with right parametrial involvement and presence of bilateral lymph node metastases. The right ureter was encased, resulting in obstruction and renal pelvic dilatation. Avid right renal subcapsular lesions were also noted, which were hyperintense on T2-weighted imaging compatible to encapsulated fluid collections. These lesions were diagnosed as subcapsular urinoma due to transmitted back pressure caused by obstruction of the right ureter.

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.

Percutaneous application of fibrin sealant in surgically recalcitrant urinomas following oncocytoma resection.

Surgical application of fibrin sealant is well established as a hemostatic agent. However, reports of its percutaneous application and its uses within the urinary tract are limited. Presented below are two patients with recalcitrant urinomas despite diversion therapy following partial nephrectomy for oncocytomas. Both patients were successfully treated with percutaneous application of fibrin sealant via a sheath at the time of percutaneous perinephric drain removal. Follow-up imaging demonstrated resolution of the urinomas with stabilization of creatinine. Percutaneous application of fibrin sealant may be considered as an alternative treatment for recalcitrant urinomas prior to surgical intervention, though more studies are required to confirm its effectiveness and safety.

Percutaneous Obliteration of Urinary Leakage after Partial Nephrectomy Using N-Butyl-Cyanoacrylate Obliteration of the Urinoma with or without Coil Embolization of the Fistula Tract.

PURPOSE: To retrospectively evaluate the safety and efficacy of the percutaneous obliteration of urinary leakage after partial nephrectomy (PN) using coils and N-butyl-cyanoacrylate (NBCA). MATERIALS AND METHODS: Data of 10 consecutive patients who underwent percutaneous obliteration of urinary leakage after PN using coil and NBCA between February 2016 and May 2018 were retrospectively reviewed. A urinary fistulography was performed via the drainage catheter. If the fistulous tract was clearly visualized, super-selective embolization of the fistulous tract with coils and urinoma cavity sealing with NBCA was performed. In cases where the fistulous tract could not be clearly visualized, only urinoma cavity sealing was performed. Outcomes and complications were assessed by reviewing medical records and computed tomography (CT). RESULTS: In 7 (70%) patients who showed obvious urinary fistulous tract, coil embolization of the urinary fistulous tract, followed by sealing of the urinoma cavity with NBCA, was performed. Obliteration of the urinoma without coil embolization of the fistula tract was performed in 3 patients (30%) in whom a distinct fistulous tract could not be visualized. The median number of treatment sessions required to achieve clinical success was 1 (range, 1-5). Four patients underwent multiple repeated procedure with successful results. All patients showed gradual decrease in size or complete disappearance of urinoma on follow-up CT without evidence of urinary leakage during the follow-up period (mean, 44.6 weeks; range, 11-117 weeks). There were no procedure-related complications. CONCLUSIONS: Percutaneous obliteration of urinary leakage after PN using coils and NBCA is safe and effective.

Factors associated with urinoma accompanied by ureteral calculi.

OBJECTIVE: Urinoma is a rare entity and mainly occurs due to acute obstruction such as ureteral stone. We aimed to demonstrate factors associated with urinoma accompanied by ureteral calculi. MATERIAL AND METHODS: Data of 550 patients who were diagnosed with ureteral stone by computed tomography (CT) were analyzed retrospectively. In 20 patients perirenal urinoma was associated with ureteral calculi (group I), whereas in other 530 patients no urinoma was detected (group II). Gender, age, size, side and localization of the stone, hydronephrosis, fever, sepsis, urinary tract infections (UTIs), hematuria, serum creatinine, blood urea nitrogen (BUN), white blood cell (WBC), C-reactive protein (CRP), presence of diabetes mellitus (DM), hypertension (HT) and cronic kidney disease (CKD) of the two groups were compared. RESULTS: The average age of the patients were 46.2 (20-71) and 44.9 (10-82) years in group I and group II, respectively (p > 0.05). According to our results leukocytosis, microscopic and macroscopic hematuria, UTIs, increase of serum creatinine, BUN and CRP, diagnosis of DM and HT were significantly associated with urinoma (p < 0.05). In addition, patients with distal ureteral stones are more prone to urinoma (p = 0.001). An interesting finding of the study was that the stone size in group I (median 5 mm [range 3-8]) was significantly smaller than in group II (9.3 mm [4-25]; p = 0.001). CONCLUSIONS: Small stone size, distal localisation of the stone in ureter, leukocytosis, hematuria, UTIs, increase of serum creatinine, BUN and CRP, presence of DM and HT are associated with perirenal urinoma.

First case of spontaneous rupture of the left ureter in immediate post-partum.

The rupture of the ureter during pregnancy is a rare complication and is most frequently observed in the right ureter. We report below the case of a rupture in the left ureter. A 36-year old woman gave birth vaginally to a 3010-g girl without operative vaginal delivery or episiotomy. The following day, the patient exhibited a sudden pain in the left side spreading to the left iliac fossa. An abdominopelvic CT scan was carried out and revealed a flow of contrast agent at the left ureteral lumbar level and a left urinoma. A ureteral stent was inserted on the left side under X-ray control. Six weeks after delivery the ureteral stent was removed. The Uro CT scan allowed us to confirm the total recovery of the left ureter. We have reported below the first case of left rupture treated in a conservative manner with positive and functional clinical progress.

Colon Visualization on Bone Scan Due to Recto-abscess Fistula From Urinoma.

The accumulation of the bone-seeking agent in the bowel during a bone scan is rare. A 68-year-old man with colon cancer underwent bone scintigraphy for staging. Whole-body images revealed an abnormal accumulation of hot radioactivity in the abdominal cavity and the colon. Abdominal CT showed a recto-abscess fistula between the rectum and the urinoma. Incidental visualization of colonic radioactivity suggested the presence of a fistula between the bowel and the urinoma, explaining the peculiar finding of the bone-seeking agent in the bowel.

Does routine repeat imaging change management in high-grade renal trauma? Results from three level 1 trauma centers.

PURPOSE: Guidelines call for routine reimaging of Grade 4-5 renal injuries at 48-72 h. The aim of the current study is to evaluate the clinical utility of computed tomography (CT) reimaging in high-grade renal injuries. MATERIALS AND METHODS: We assembled data on 216 trauma patients with high-grade renal trauma at three level 1 trauma centers over a 19-year span between 1999 and 2017 in retrospectively collected trauma database. Demographic, radiographic, and clinical characteristics of patients were retrospectively reviewed. RESULTS: In total, 151 cases were Grade 4 renal injuries, and 65 were Grade 5 renal injuries. 53.6% (81) Grade 4 and 15.4% (10) Grade 5 renal injuries were initially managed conservatively. Of the 6 asymptomatic cases where repeat imaging resulted in intervention, 100% had collecting system injuries at initial imaging. Collecting system injuries were only present in 42.9% of cases where routine repeat imaging did not trigger surgical intervention. Collecting system injury at the time of initial imaging was a statistically significant predictor of routine repeat imaging triggering surgical intervention (p = 0.022). Trauma grade and the presence of vascular injury were not significant predictors of intervention after repeat imaging in asymptomatic patients. CONCLUSION: In asymptomatic patients with high-grade renal trauma, the number needed to image is approximately one in eight (12.5%) to identify need for surgical intervention. There is potentially room to improve criteria for routine renal imaging in high-grade renal trauma based on the more predictive imaging finding of collecting system injury.

Case report: urinoma in the proximal thigh mimicking a soft tissue neoplasm.

Soft tissue tumors form a heterogeneous group of benign and malignant lesions. Those with a high fluid content may be particularly challenging in diagnosis. We present a 78-year-old man with a dolorous, progressive mass in the adductor region of the lower left extremity. At the end of a long diagnostic pathway, the pseudocystic tumor was eventually identified as a urinoma, caused by a prostatosymphyseal fistula that had occurred as a late complication of transurethral resection of the prostate. Our finding represents a rare variant of soft tissue tumors in the lower extremities, which MR-based urography can help to reveal.

Utility of Cystatin C in the Setting of Urinoma.

BACKGROUND: Elevated serum creatinine levels are a common finding in patients with urinoma (i.e. presence of urine outside of the urinary tract). Therefore, in the clinical circumstance of an urinoma, utilizing a creatinine-based estimated GFR (eGFR) to determine renal function is unreliable, as it fails to distinguish true renal failure from pseudorenal failure in patients with a urine leakage. Cystatin C, a 13 kDA molecular mass protein ubiquitously expressed by nucleated cells, offers superior accuracy in the setting of an urinoma, since unlike creatinine, it is essentially absent in excreted urine and poorly reabsorbed from the peritoneum and retroperitoneal space. METHODS: We present the first case report to demonstrate the utility of cystatin C in an adult patient with native kidney function that experienced significant retro-peritoneal bladder leakage. RESULTS: Our results demonstrate that cystatin C may be a more accurate measurement of GFR than the commonly used creatinine in the setting of an urinoma. CONCLUSION: In order to achieve an accurate estimated GFR in the setting of a urinoma, physicians should consider the use of Cystatin C, which is less vulnerable to inaccurate interpretation.

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.