Soft tissue infection after photoselective vaporization of the prostate: a life-threating complication.

Bladder outlet obstruction is a common aetiology of lower urinary tract symptoms in adult men and several treatment options are available. We report on a case of a 73-year-old man with a complicated soft tissue infection due to an urinoma after laser prostatectomy. He was treated by several surgical interventions and long-term antibiotic therapy.

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.

Impact of prenatal urinomas in patients with posterior urethral valves and postnatal renal function.

OBJECTIVE: Posterior urethral valves (PUV) are a common cause of lower urinary tract obstruction. Renal failure occurs in approximately one third of the cases. It is debated whether urinoma formation is a protective mechanism to reduce pressure-related impairment of renal function. The aim of our study was to determine if urinoma formation is able to preserve renal function on the side of the urinoma. METHODS: Five male patients diagnosed with posterior urethral valves and uni- or bilateral urinoma formation were reviewed. Renal function was assessed by serum creatinine level at days 4-7 and at two months, in addition to dimercaptosuccinylacid (DMSA) scintigraphy at 4-6 weeks postnatal age. RESULTS: Impaired renal function occurred unilaterally in four patients, two had bilateral urinoma formation, and the other two boys presented with unilateral urinoma, one with preserved renal function ipsilateral to the urinoma and the other on the contralateral side. Urinary ascites was detected in three patients, all underwent antenatal centesis. CONCLUSIONS: No association was found between renal function and urinoma formation in patients with PUV.

Fetal urinoma: two new cases and a review of the literature.

OBJECTIVE: To evaluate the functional prognosis of kidneys affected prenatally by urinomas. METHODS: This was a retrospective review of cases of fetal urinoma reported in the literature, as well as two of our own cases. RESULTS: Twenty-three patients with a prenatal diagnosis of urinoma (five bilateral) were included in the analysis. Postnatal ipsilateral renal function was observed in only six of the 28 renal units (i.e. around 20%). CONCLUSIONS: Although the precise causes of urinomas are still unknown, this review shows that in the event of a fetal urinoma, the probability of a non-functional dysplastic ipsilateral kidney lies at around 80%. In-utero puncture only appears to be justified in cases where fluid accumulation has mass effects on adjacent major structures.