Peripelvic Extravasation, Urinoma Formation and Tumor Obstruction of the Ureter

Abstract

We report 4 cases of peripelvic extravasation caused by tumor obstruction of the ureter. A urinoma developed in 3 of the 4 cases. Review of the literature reveals only 5 previously reported cases of peripelvic extravasation secondary to tumor obstruction of the urinary tract. We discuss the mechanics of peripelvic extravasation and urinoma formation, and conclude that tumor obstruction of the ureter must be considered in all cases of peripelvic extravasation.

Urinoma – A Rare Presentation of Carcinoma of the Bladder

“…The remaining 20% were idiopathic in that no cause could be determined. In 4 cases of peripelvic extravasa tion reported by Twerskey et al [7], 3 formed urinoma. All 4 cases reported by them had a tumor and 1 was car cinoma of the bladder as in our case.…”

“…After 10-12 days fibroplas tic activity starts and in 3-6 weeks dense collagenous con nective tissue forms the wall of the extravasated urine now called urinoma. Urinomas are usually not associated with chronic obstruction [7], The obstruction which initiates the development of a urinoma could be from external trauma, surgical proce dures including instrumentation of the urinary tract, ex ternal compression of the ureter from a retroperitoneal …”

Spontaneous Peripelvic Extravasation due to Squamous Cell Carcinoma of the Ureter

“…Khan and Malek [3] reported a case of spontaneous urinary extravasa tion due to ureteral transitional cell carcinoma as well as 11 patients with spontaneous extravasation whose etiology were mostly due to acute ureteral obstruction by calculi. Only a limited number of cases with extrava sation caused by tumor obstruction of the ureter was reported [4][5][6]. Most of their underlying lesions were metastatic lesions to retroperitoneal lymph nodes, blad der or prostate carcinoma.…”

Secondary urinoma mimicking recurrent tumor as a cause of bilateral ureteral obstruction

“…Diagnostic procedures using contrast media that is concentrated by the kidneys are of limited value in the face of an elevated serum creatinine and may induce further deterioration of renal function [3]. Computerized tomographic scans may have a similar limitation and are more expensive [7].…”

“…Urinary extravasation with urinoma formation due to distal obstruction has been previously reported, usually secondary to benign disease [ 1,2]. Only 8 cases secondary to tumor have been reported, probably because tumors usually cause a more chronic form of obstruction than stones or most other benign conditions [3,4]. Urinoma formation as a complication of nephrostomy tube insertion has also been reported but is rare since the extravasate usually drains around the nephrostomy catheter [5].…”