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Prat E, Seo-Mayer P, Agarwal S. Neonate with urinary ascites but no hydronephrosis: unusual presentation of posterior urethral valves. BMJ Case Rep 2018; 2018:bcr-2018-225053. [PMID: 30317193 DOI: 10.1136/bcr-2018-225053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Posterior urethral valves (PUV) are an important cause of paediatric obstructive uropathy. PUV are usually diagnosed by prenatal ultrasonography (US) revealing hydronephrosis and bladder distention. We describe a 17-day-old male infant with abdominal distention who had no hydronephrosis on prenatal US. Laboratory investigations showed serum creatinine of 12 mg/dL, hyperkalaemia and metabolic acidosis. Abdominal US showed large amount of ascites, normal-sized kidneys without hydronephrosis and incompletely distended bladder. Paracentesis revealed clear, yellow ascitic fluid with creatinine level of 27 mg/dL compatible with urinary ascites. Voiding cystourethrogram (VCUG) demonstrated PUV with a dilated posterior urethra, grade 5 right vesicoureteral reflux and a ruptured kidney fornix with peritoneal extravasation of contrast. Foley decompression resulted in normalisation of creatinine within 72 hours. Transurethral resection of PUV was performed, and a repeat VCUG showed recovery of forniceal rupture. This case illustrates an unusual presentation of a potentially life-threatening but treatable cause of urinary tract obstruction.
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Affiliation(s)
- Elisabetta Prat
- Pediatrics, Inova Children's Hospital, Falls Church, Virginia, USA
| | - Patricia Seo-Mayer
- Pediatric Nephrology, Pediatric Specialists of Virginia, Fairfax, Virginia, USA
| | - Swati Agarwal
- Pediatric Critical Care, Inova Children's Hospital, Falls Church, Virginia, USA
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2
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Taşkınlar H, Yiğit D, Avlan D, Naycı A. Unusual complication of a urinary stone in a child: spontaneous rupture of the renal pelvis with the migration of calculus into the retroperitoneum. Turk J Urol 2016; 42:48-50. [PMID: 27011883 DOI: 10.5152/tud.2015.94467] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Spontaneous perforation of the renal pelvis and extravasation of urine into the perinephric space is an extremely rare condition in childhood. It is mostly related to underlying congenital urinary tract abnormalities and caused by urolithiasis or infection in the setting of urinary obstruction. Here, we report a case of an 18-month-old female patient with rupture of the renal pelvis by an extruded kidney stone and its management.
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Affiliation(s)
- Hakan Taşkınlar
- Department of Pediatric Surgery, Mersin University School of Medicine, Mersin, Turkey
| | - Doğakan Yiğit
- Department of Pediatric Surgery, Mersin University School of Medicine, Mersin, Turkey
| | - Dinçer Avlan
- Department of Pediatric Surgery, Mersin University School of Medicine, Mersin, Turkey
| | - Ali Naycı
- Department of Pediatric Surgery, Mersin University School of Medicine, Mersin, Turkey
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Spaggiari E, Dreux S, Czerkiewicz I, Favre R, Schmitz T, Guimiot F, Laurichesse Delmas H, Verspyck E, Oury JF, Ville Y, Muller F. Fetal obstructive uropathy complicated by urinary ascites: outcome and prognostic value of fetal serum β-2-microglobulin. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2013; 41:185-189. [PMID: 23090907 DOI: 10.1002/uog.12328] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/02/2012] [Indexed: 06/01/2023]
Abstract
OBJECTIVES To determine whether the prognostic value of fetal serum β-2-microglobulin is altered and whether the occurrence of fetal urinary ascites prevents kidney damage in cases of fetal obstructive uropathy with urinary ascites. METHODS This was a retrospective study of cases of fetal bilateral obstructive uropathy that occurred between 2006 and 2010, for which both fetal serum and ascites samples were sent to our laboratory for analysis. β-2-microglobulin was assayed in both fetal serum and the corresponding ascites. Renal outcome was analyzed. Histological features of the kidney in cases of termination of pregnancy and renal function of liveborn infants were recorded. RESULTS Fourteen cases with analysis of fetal serum and fetal ascites in a context of urinary obstruction were included. Renal outcome was unfavorable in eight cases (57%) and favorable in six (43%). When fetal serum β-2-microglobulin was < 5 mg/L, renal outcome was favorable in all cases (4/4). When fetal serum β-2-microglobulin was ≥ 5 mg/L, 8/10 cases (80%) had an unfavorable renal outcome (sensitivity, 100%; specificity, 66%). CONCLUSION Fetal serum β-2-microglobulin reliably predicts postnatal renal outcome in obstructive uropathy complicated by urinary ascites. Moreover, urine extravasation does not seem to protect fetal renal function.
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Affiliation(s)
- E Spaggiari
- Department of Developmental Biology, AP-HP, Robert Debré Hospital, and University Paris Diderot and Paris Sorbonne-Cité, Paris, France.
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4
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[Spontaneous intraperitoneal rupture of hydronephrosis in an infant]. Arch Pediatr 2012; 19:1316-8. [PMID: 23107088 DOI: 10.1016/j.arcped.2012.09.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2012] [Revised: 05/19/2012] [Accepted: 09/20/2012] [Indexed: 11/22/2022]
Abstract
Spontaneous intraperitoneal rupture of hydronephrosis is a rare complication. We report a case in a 30-month old boy admitted for fever, with a temperature up to 38.5°C, and abdominal distension. The diagnosis was made intraoperatively. The treatment consisted of an emergency internal urinary diversion and a deferred definitive cure of the pyelo-ureteral junction stenosis. Surgical management in two steps is more prudent and beneficial.
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Affiliation(s)
- Boris Gershman
- Department of Urology, Massachusetts General Hospital, Harvard Medical School, Boston, 02114, USA
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Kuwata T, Matsubara S, Nakamura S, Nakai H. Urinary ascites in a fetus with posterior urethral valve: antenatal diagnosis. Pediatr Int 2011; 53:281-2. [PMID: 21501317 DOI: 10.1111/j.1442-200x.2011.03344.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Adorisio O, Silveri M, Colajacomo M, Bassani F, Rivosecchi M. The impact of perinatal urinoma formation on renal function: our experience and review of the literature. J Paediatr Child Health 2011; 47:217-22. [PMID: 21199055 DOI: 10.1111/j.1440-1754.2010.01927.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
INTRODUCTION A urinoma is a fluid mass consisting of extravasated urine in the perirenal space. Its impact on renal function was analysed. METHODS All cases of prenatal and neonatal urinoma reported in the literature were analysed as well as two cases recently observed in our department. RESULTS A review of all prenatally diagnosed urinomas revealed 25 cases, for a total of 30 renal units. The cause of obstruction was: lower urinary tract (LUT) obstruction in 16 cases (62.5%), upper urinary tract (UUT) obstruction in seven cases (29.5%) and unknown in two cases (8%). A preserved renal function was found in only 30% of all cases. Furthermore, prognosis for renal function was better in posterior urethral valve (PUV) patients than in uretero-pelvic junction obstruction (UPJO) patients. In addition, we analysed 35 published cases of urinoma with a neonatal onset, without prenatal diagnosis, and secondary to LUT obstruction in 27 cases (77%), UUT obstruction in seven cases (20%), while the underlying cause was unknown in one cases (3%). A preserved renal function was observed in 84% of cases with UUT obstruction and in 80% of cases presenting a LUT obstruction. CONCLUSIONS Prognosis concerning renal function seems to be mainly related to two factors: age at presentation and underlying diagnosis. Decompression of the urinary tract by urine extravasation produces the best results in terms of preservation of the renal function in LUT obstruction (75% in prenatal and 84% in postnatal cases); UUT obstruction however is associated with a good prognosis in the neonatal period (80% of preserved renal function) but with a severe impairment (only 20% of preserved renal function) in prenatally detected cases.
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Affiliation(s)
- Ottavio Adorisio
- Department of Pediatric Surgery, Bambino Gesù Children's Hospital, Research Institute, Rome, Italy.
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8
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Baldisserotto M, Fiori H, Fiori R, Ferrari LHR, Mizerkowski MD. Neonato com ascite urinária e ruptura de cálice renal secundárias a válvula de uretra posterior: diagnóstico ultrassonográfico. Radiol Bras 2011. [DOI: 10.1590/s0100-39842011000100015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
A literatura relata somente alguns casos de recém-nascidos com ascite urinária, geralmente secundária a ruptura de bexiga urinária e não de um cálice renal. Este relato de caso descreve um caso raro de ascite urinária em recém-nascido com válvula de uretra posterior que teve ruptura de um cálice renal, neste caso diagnosticada, até onde sabemos, pela primeira vez por ultrassonografia.
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Affiliation(s)
| | - Humberto Fiori
- Pontifícia Universidade Católica do Rio Grande do Sul, Brasil
| | - Renato Fiori
- Pontifícia Universidade Católica do Rio Grande do Sul, Brasil
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10
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Wells JM, Mukerji S, Chandran H, Parashar K, McCarthy L. Urinomas protect renal function in posterior urethral valves--a population based study. J Pediatr Surg 2010; 45:407-10. [PMID: 20152362 DOI: 10.1016/j.jpedsurg.2009.10.084] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2009] [Accepted: 10/27/2009] [Indexed: 10/19/2022]
Abstract
BACKGROUND/PURPOSE Urinomas have been thought to protect renal function in boys with posterior urethral valves (PUVs), although recent reports have disputed this. This study tested the hypothesis that urinomas protect global renal function in boys with PUV. METHODS A retrospective analysis of all boys with PUV presenting to a tertiary unit derived from a region with an estimated population of 5.5 million was performed. Comparisons of the initial nadir creatinine, current creatinine, and renal status score (RSS) were made between those with and without urinomas. The RSS was derived from nephrology assessment of current renal status (0 = normal to 4 = end-stage renal failure or transplantation). Results were given as median (range), except for RSS, which was given as mean +/- SEM. P < or = .05 was regarded as significant. RESULTS During 1989-2009, 9 of 89 PUV boys were diagnosed with urinomas. Initial nadir creatinine was statistically lower in boys with urinomas (31 [18-44] vs 45 [20-574] mumol/L, P < .01). Length of follow-up was similar (5.1 [2.2-17.3] vs 5.9 [1.8-19.7] years, P = .59). Follow-up creatinine was significantly lower in urinoma boys (44 [25-77] vs 61 [29-1227] micromol/L, P < .05), as was the RSS (0.14 +/- 0.14 vs 0.91 +/- 0.14, P < .01). No urinoma boys progressed to end-stage renal failure or required transplant. CONCLUSION This population-based study of PUV boys demonstrates that urinomas reduce nadir creatinine and significantly protect long-term global renal function.
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Affiliation(s)
- J M Wells
- Department of Paediatric Urology, Birmingham Children's Hospital, UK
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Spasojevic S, Pavlovic V, Stojanovic V, Kovacevic B, Doronjski A. Prenatal urinary ascites due to the idiopathic bladder rupture. J Matern Fetal Neonatal Med 2009; 22:537-9. [DOI: 10.1080/14767050802702331] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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12
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Alpert SA, Noe HN. Furosemide nephrolithiasis causing ureteral obstruction and urinoma in a preterm neonate. Urology 2004; 64:589. [PMID: 15351602 DOI: 10.1016/j.urology.2004.04.049] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2003] [Revised: 04/26/2004] [Accepted: 04/26/2004] [Indexed: 11/29/2022]
Abstract
Nephrolithiasis and nephrocalcinosis in low-birth-weight, preterm neonates are well-documented complications of furosemide administration. Perinephric urinomas and urinary ascites have been previously reported as complications of obstruction due to posterior urethral valves or ureteropelvic junction obstruction. We present an unusual case of furosemide-induced nephrolithiasis causing ureteral obstruction, urinoma, and acute renal failure in a preterm neonate.
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Affiliation(s)
- Seth A Alpert
- Department of Pediatric Urology, LeBonheur Children's Medical Center, University of Tennessee, Memphis, Tennessee, USA
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Beetz R, Stein R, Rohatsch P, Brzezinska R, Thüroff JW. Acute perirenal extravasation of urine in an infant with non-refluxing megaureter. Pediatr Nephrol 2004; 19:357-60. [PMID: 14685844 DOI: 10.1007/s00467-003-1383-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2003] [Revised: 10/24/2003] [Accepted: 11/11/2003] [Indexed: 11/29/2022]
Abstract
Perirenal extravasation of urine is a rare event in congenital uropathies, mostly observed perinatally in the case of infravesical obstruction. We describe a male infant with a primary non-refluxing obstructive left megaureter who developed an acute perirenal extravasation and ascites at the age of 4 weeks. After temporary upper urinary diversion, ureterocystoneostomy was successfully performed. Intraoperatively, the distal ureter showed an extremely narrow lumen over a distance of 3 cm. In the current literature, postnatal management of primary megaureters is preferably conservative. Our patient demonstrates an extremely rare complication demanding early surgical intervention.
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Affiliation(s)
- Rolf Beetz
- Pediatric Clinic, University Clinics of Mainz, Langenbeckstrasse 1, 55131 Mainz, Germany.
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Checkley AM, Sabharwal AJ, MacKinlay GA, Munro FD, Orr JD. Urinary ascites in infancy: varied etiologies. Pediatr Surg Int 2003; 19:443-5. [PMID: 12740705 DOI: 10.1007/s00383-002-0938-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/11/2002] [Indexed: 11/29/2022]
Abstract
Three cases of urinary ascites are presented, each with a different underlying aetiology. The age and modes of presentation also varied and management strategies were accordingly tailored to each patient's clinical requirements. All 3 patients survived and subsequently were discharged with good renal function. Although a rare condition, infants with urinary ascites can present as clinical emergencies in need of prompt resuscitation with subsequent drainage of the urine and decompression of the urinary tract. The ultimate management regime will vary and depend upon site of urinary extravasation and underlying aetiology.
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Affiliation(s)
- A M Checkley
- Department of Pediatric Surgery, Royal Hospital for Sick Children, Edinburgh, UK
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15
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Patil KK, Wilcox DT, Samuel M, Duffy PG, Ransley PG, González R. Management of urinary extravasation in 18 boys with posterior urethral valves. J Urol 2003; 169:1508-11; discussion 1511. [PMID: 12629405 DOI: 10.1097/01.ju.0000056960.06376.c2] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE Urinary extravasation with associated posterior urethral valves is uncommon and published articles are restricted to case reports. We propose a management algorithm on the basis of presentation of 18 boys with this condition. MATERIALS AND METHODS In this retrospective review we analyze the clinical features, diagnostic radiological imaging (voiding cystourethrogram and (99m)technetium mercaptoacetyltriglycine scan) and measured glomerular filtration rate (GFR) for assessment of renal function in boys presenting with posterior urethral valves and urinary extravasation. Indications for surgical intervention and long-term outcome were evaluated. Results are presented as mean +/- SD. RESULTS Patient age at presentation was 4 days (range 1 to 28). Salient features at presentation were abdominal distention in 55.5% of cases, flank mass in 55.5%, respiratory distress in 16.6% and septicemia in 22.2%. Patients were categorized into group 1 with ascites (6 boys) and group 2 without ascites (12). Followup was 70.8 +/- 5.6 months. In group 1 the 3 boys with ascites alone had a followup GFR of 29 versus 74 ml. per minute per 1.73 m.2 in 3 with urinoma plus ascites (p = 0.001) at 64 +/- 4.9 months. In group 2 the GFR in 3 boys with bilateral urinoma was 104.7 +/- 30.4 versus 54.3 +/- 29.4 ml. per minute per 1.73 m.2 in the other 9 with unilateral urinoma (p = 0.001) at 36 +/- 4.2 and 81.3 +/- 4.7 months, respectively. The ipsilateral kidney showed reduced function in 6 of 12 boys with unilateral urinoma from both groups. CONCLUSIONS Renal function on the side of the urinoma is impaired, and the majority of patients have impaired global renal function. A management algorithm is proposed.
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Affiliation(s)
- K K Patil
- Department of Paediatric Urology, Great Ormond Street Hospital for Children NHS Trust, London, United Kingdom
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IN UTERO PERINEPHRIC URINOMA AND URINARY ASCITES WITH POSTERIOR URETHRAL VALVES: A PARADOXICAL POP-OFF VALVE? J Urol 2001. [DOI: 10.1016/s0022-5347(05)65597-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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IN UTERO PERINEPHRIC URINOMA AND URINARY ASCITES WITH POSTERIOR URETHRAL VALVES:. J Urol 2001. [DOI: 10.1097/00005392-200112000-00103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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