Urine Leaks and Urinomas: Diagnosis and Imaging-guided Intervention

Abstract

Urine leaks from the kidney, ureter, bladder, and urethra most commonly result from trauma. Urinomas may be occult initially and may lead to complications such as abscess formation and electrolyte imbalances if not promptly diagnosed and appropriately managed. Radiologists play a key role in diagnosing urine leaks and determining their cause and extent. Contrast material-enhanced computed tomography (CT) with delayed imaging, CT cystography, and retrograde urethrography are the diagnostic imaging studies of choice. Studies such as intravenous pyelography, antegrade and retrograde pyelography, renal scintigraphy, and imaging-guided needle aspiration may play complementary diagnostic roles. In some instances, the role of the radiologist ends with the diagnosis of urine leaks, after which patients are treated conservatively or perhaps surgically. Uncomplicated renal urine leaks, extraperitoneal urinary bladder rupture, and type 1 urethral injuries are generally managed conservatively. Urine leaks that require more extensive, imaging-guided treatment can usually be managed safely and effectively with a combination of percutaneous urinoma drainage catheters, percutaneous nephrostomy catheters, ureteral stents, and bladder drainage. In the appropriate setting, use of these management options may reduce urinoma-related complications and limit or totally eliminate the need for urologic surgery.

Unusual complication of a urinary stone in a child: spontaneous rupture of the renal pelvis with the migration of calculus into the retroperitoneum

“…The most useful imaging study to identify cystic or solid masses with calcifications is abdominal CT. Additionally, delayed images usually show extravasation of the contrast medium and provides information regarding the perforation site. [6,7] In the present study, we confirmed not only the contrast medium extravasation but also showed extruded calculus in the perirenal space by contrastenhanced CT study. To avoid unnecessary exposure to radiation to a growing female child, we only followed the patient with plain roentgenogram and ultrasound studies; hence, we did not perform a second CT after no calculus was revealed in plain X-ray and ultrasonographic images.…”

“…Additional use of a Unusual complication of a urinary stone in a child: spontaneous rupture of the renal pelvis with the migration of calculus into the retroperitoneum nephrostomy catheter or a ureteral stent with a percutaneous drainage catheter improves the diversion of the urine from the ruptured area and accelerates healing of the injured collecting system. [7] In our case, we initially placed an ultrasound-guided drainage catheter into the urinoma; then, the placement of a JJ stent was attempted but was unsuccessful. The catheter was kept for 4 weeks until the urine output stopped by the end of this 4-week period.…”

Tubeless percutaneous nephrolithotomy: outcomes with expanded indications

“…However, the urologic trauma literature supports the use of a ureteral stent in the management of a collecting system injury, suggesting that such an approach would be appropriate also after PCNL (29). The retrospective nature of our study carries inherent risk for selection bias; prospective randomized trials would more definitively address the questions posed.…”

MDCT technique and imaging findings of urinary stone disease: an expanded review

“…Indications for contrast-enhanced CT evaluation (based on unenhanced CT findings) are: i) presence of unilateral perinephric stranding without hydroureteronephrosis with or without renal enlargement (acute renal infarction, renal vein thrombosis, acute pyelonephritis); ii) significant hypo-/ hyperdense perirenal collection (urinoma, hematoma) with or without the b a presence of hydroureteronephrosis; iii) presence of a mass or complicated cyst with/without calculus; iv) negative unenhanced CT findings in a patient with unexplained hematuria (52). Common clinical conditions requiring contrastenhanced CT after unenhanced CT scan in a patient presenting with flank pain and hematuria are infections, neoplasms, renal cyst complications, vascular lesions, urinoma and acute perirenal hematoma, of which imaging findings are already defined elsewhere (51)(52)(53)(54)(55).…”