Urinoma after renal tumor enucleation

Case contributed by Dr Dominik Maas

Presentation

7 days post tumor enucleation of the right kidney, the patient experienced decreasing renal function, rising inflammation parameters, and a swollen area at the operative site as well as scrotal and penile oedema.

Patient Data

Age: 50 years
Gender: Male

Surgical clips along the right side of the abdomen with small air pockets in the peritoneum.
There are also fluid and air-pockets in the right perirenal space. This fluid exhibit HU values 10 to 15. 
Right kidney reduced enhancement compared to the normal left kidney. A right renal parenchymal defect in keeping with recent tumor enucleation. 
The proximal end of the right nephroureteral catheter is displaced into the right pyeloureteral junction. 

 

CT

Urogram - 20 minutes

20 min delayed phase. A slight enhancement of the perirenal fluid can be seen, but no extravasation. The contrast agent is already in the renal pelvis and ureter of the left kidney.

CT

Urogram - 90 minutes

90 min delayed. An increased attenuation of the perirenal fluid and extravasation through the parenchymal defect of the kidney can be observed.

Fluoroscopy

Retrograde contrast administration and replacement of the nephroureteral catheter of the right kidney to reestablish urine flow into the bladder and decreased pressure in the upper collecting system. Small laterodorsal extravasation can be observed.

Case Discussion

7 days after tumor enucleation of the right kidney, the patient experienced decreasing renal function, rising inflammatory parameters.

A multiphase CT scan was performed. After a 20 min delayed phase, it was not clear if the fluid in the right pararenal space was a urinoma. Only after 90 min, increased attenuation of the perirenal fluid (and extravasation) can be detected.

The dislocated nephroureteral catheter may have led to increased pressure in the upper collecting system, contributing to the formation of the urinoma.

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Case information

rID: 35533
Published: 10th Apr 2015
Last edited: 10th May 2019
System: Urogenital
Inclusion in quiz mode: Included

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