Abdominal urinoma after oncologic gynaecological surgery

A woman in her latye 70s with a history of hysterectomy indicating endometrioid endometrial adenocarcinoma and micrometastases on sentinel lymph node biopsy (stage pT2N1) was admitted for abdominal pain lasting for 5 days developing 2 days after lumboaortic lymphadenectomy. The patient was afebrile. A sensitive mass was palpable in the left flank. Serum creatinine level was 135 µmol/L (64 µmol/L 1 week before), C reactive protein level 38 mg/L. Ultrasonography showed a left retroperitoneal anechoic fluid-filled mass. CT scan without contrast confirmed this mass 15×10×22 cm pushing the left kidney (figure 1A,B). A percutaneous drainage removed 2700 mL of a yellow liquid with a creatinine level of 1519 µmol/L, confirming the diagnosis of urinoma with pain relief and biological tests' normalisation. Ureteral double-J stent could not be inserted because of a left proximal lumbar ureter injury, requiring percutaneous nephrostomy, with ureteral leak on CT scan with contrast (figure 1C).

Urinoma is a collection of urine out of the normal pathway from the kidney, ureter, bladder or urethra.¹ It can develop from the upper abdomen down to the low pelvis,¹ rarely in the thorax,² due to injuries during abdominal and pelvic surgery, rarely because of obstruction of the urinary tract (urinary stone, tumours). Diagnosis relies on ultrasonography and CT scan showing a fluid collection. Aspiration of the fluid with measurement of the creatinine level allows definite diagnosis.¹ CT scan can also indicate the source of the leak on the excretion acquisition. Resolution of urinoma can be spontaneous but percutaneous drainage is mandatory when it is infected or to reduce pain and pressure on adjacent structures.¹

Ethics statements

Patient consent for publication

Not required.

References

Footnotes