Urinothorax: A rare complication of percutaneous nephrostomy

Kelley, Michael J.; Spieler, Bradley; Rouse, Christopher; Karl, Bob; Marshall, Richard; Carbonella, Gregory

doi:10.1016/j.radcr.2019.03.022

Cited by 8 publications

(6 citation statements)

References 16 publications

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“…Deteriorating renal function and rapid accumulation of pleural effusion in these patients implies the possibility of urinothorax. Retrograde pyelogram, contrast-enhanced CT, and renal scintigraphy are useful tools for identifying the presence of reno-pleural fistula [ 15 , 16 ].…”

Section: Discussionmentioning

confidence: 99%

“…A pleural fluid/serum creatinine ratio > 1 is regarded as the hallmark criterion but it has low specificity. Other characteristics include urine-like color or odor, transudative effusion by Light’s criteria, and a total pleural fluid protein < 1 mg/dL [ 15 ]. As the pleural effusion of our patient was apparently urine which flowed directly through the ureteric stent, the creatinine concentration was not examined.…”

Section: Discussionmentioning

confidence: 99%

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Intrathoracic ureteric stent migration through a reno-pleural fistula: a case report of rare antegrade ureteric stenting complication

Chen

2021

BMC Women's Health

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Background Malignant obstruction and associated hydronephrosis is a common complication of advanced cervical cancer. Percutaneous nephrostomy (PCN) followed by antegrade stenting is often required to relieve obstruction as retrograde access fails in considerable proportion of such patients. Reno-pleural fistula is a rare complication of PCN which creates a patent connection between the renal collecting system and the thoracic cavity, and urine accumulation in the pleural space can cause pleural effusion (i.e., urinothorax). Upward or downward migration is a complication of indwelling ureteric stents. Further migration with extrusion outside of the urinary tract is uncommon. Herein we present an unprecedented case in adult of ureteric stent upward migration through a reno-pleural fistula into the thoracic cavity managed by thoracoscopy. Case presentation A 66-year-old female was diagnosed of advanced stage cervical cancer with suspicious bladder invasion. Given her bilateral hydronephrosis with impaired renal function, she underwent bilateral PCN and subsequent antegrade ureteric stenting. However, she presented with dyspnea, right back pain, and oliguria four days after bilateral PCN catheter removal. Computed tomography reported massive right pleural effusion and an intrathoracic ureteric stent within reno-pleural fistula. Thoracoscopy with thoracostomy was performed to remove the ureteric stent and urine in right pleural space. A week later, urinothorax had resolved and right PCN was performed again. She was discharged after regaining normal renal function with right PCN and a left ureteric stent in place. Conclusions A reno-pleural fistula can serve as a route for ureteric stent migration and that continuous drainage of urine can cause urinothorax once the stent reaches the thoracic cavity. Anytime a supracostal approach is used for PCN, even when using small caliber catheters, clinicians should pay special attention given the risk of pleural injury and subsequent complications.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Intrathoracic ureteric stent migration through a reno-pleural fistula: a case report of rare antegrade ureteric stenting complication

Chen

2021

BMC Women's Health

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“…En el paciente presentado, este paso se obvió al debutar con un derrame multitabicado que requirió tratamiento quirúrgico. En cualquier caso, el urinotórax persistirá mientras no se corrija la afección genitourinaria que lo generó 2,16 .…”

Section: Tratamientounclassified

Urinotórax: una rara complicación de la nefrolitotomía percutánea: reporte de un caso

Pérez-Palenzuela¹,

Sosa-Martín²,

Pérez-García³

et al. 2021

CIRU

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El urinotórax es una causa inusual de derrame pleural. Se describe un caso de urinotórax secundario a trauma del sistema urinario. Varón de 41 años que reingresa en el hospital a los 16 días de someterse a una nefrolitotomía percutánea derecha, con fiebre, disnea y dolor torácico. Se confirma por tomografía derrame pleural multitabicado, que se resolvió con tratamiento quirúrgico. Reingresa 21 días después con empiema recidivante y se diagnostica una fístula renopleural, que fue tratada con retoracotomía y colocación de catéter doble J y sonda vesical. La sospecha diagnóstica y el manejo multidisciplinario permitieron resolver esta rara complicación.

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“…Urinothorax is a rare and underdiagnosed cause of pleural effusion, typically a transudate. It can occur at any age and it is more frequent in males [1] . The accumulation of urine in the pleural space is usually the result of: (a) bilateral urinary obstruction; (b) genitourinary tract trauma; or (c) iatrogeny (for instance after nephrostomy tube placement, renal biopsy or lithotripsy) [2] .…”

Section: Introductionmentioning

confidence: 99%

Pleural Effusion Secondary to Obstructive Uropathy: A Case of Urinothorax

Freitas

Coelho

Beça

et al. 2020

European Journal of Case Reports in Internal Medicine

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Urinothorax is a rare type of pleural effusion and usually the result of genitourinary tract disease. An accurate and early diagnosis is crucial as resolution of the underlying pathology is the mainstay of treatment. We report the case of a 69-year-old man who was admitted to the Internal Medicine ward due to obstructive acute kidney injury of unknown origin. The patient was submitted to urinary catheterization and to right percutaneous nephrostomy. Two weeks after admission he developed a large left pleural effusion; a left urinoma was also visible on computed tomography. After thoracentesis, pleural fluid analysis demonstrated a paucicellular transudate with pH <7.40 and pleural fluid/serum creatinine ratio >1.0. The diagnosis of urinothorax was made and further study allowed the diagnosis of prostate cancer as the aetiology of the obstruction. When bilateral percutaneous nephrostomy was performed, resolution of the urinothorax and normalization of renal function occurred.

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Urinothorax: A rare complication of percutaneous nephrostomy

Cited by 8 publications

References 16 publications

Intrathoracic ureteric stent migration through a reno-pleural fistula: a case report of rare antegrade ureteric stenting complication

Intrathoracic ureteric stent migration through a reno-pleural fistula: a case report of rare antegrade ureteric stenting complication

Urinotórax: una rara complicación de la nefrolitotomía percutánea: reporte de un caso

Pleural Effusion Secondary to Obstructive Uropathy: A Case of Urinothorax

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