Bilateral nephrostomy with urinoma drain

Case contributed by Travis Fahrenhorst-Jones

Presentation

Acute eGFR drop to 10. Previously known hydronephrosis.

Patient Data

Age: 85 years
Gender: Male
  • moderately severe bilateral hydronephrosis and hydroureter to the bladder level
  • fluid collection posterior to the left renal pelvis extending into the left posterior perirenal space inferiorly likely representing a urinoma due to left renal pelvic rupture
  • mildy enlarged prostate 
  • two 8 French pigtail catheters were inserted utilizing a Seldinger technique under CT guidance; one into each collecting system - both drained blood-stained urine
  • an 8 French pigtail catheter was also inserted into the urinoma; freely draining clear urine
  • post insertion nephrostograms confirm correct placement of catheters

Case Discussion

The patient tolerated the procedure well and a reversal of the acute drop in eGFR occurred in the days following the procedure. 

85%-90% of percutaneous nephrostomies are performed to treat urinary tract obstruction; often with superimposed infection 1. In this case the cause of obstruction was thought to likely be a urothelial malignancy. Cases that include azotemia should be performed on an urgent basis while a gram-negative urosepsis warrants an emergency procedure 1.

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