Perinephric urinoma secondary to neurogenic bladder in myelodysplasia

Perinephric Urinoma Secondary to Malignancy in a Pediatric Patient

Perinephric urinomas commonly arise following traumatic injury or high-grade obstruction from kidney stones or lower urinary tract disorders. Not only are spontaneous urinomas rare in the pediatric population, but malignancy presenting with perinephric urinomas have only been described in the adult population. In this case report, we report flank pain from a spontaneous perinephric urinoma as the presenting symptom of lymphoma in a pediatric patient.

Emphysematous urinoma as a complication of emphysematous pyelitis in a healthy adult male

Emphysematous pyelitis and urinomas are independently rare conditions. The former is a severe necrotizing infection involving the renal collecting system, the latter an encapsulated collection of urine in the perinephric or paraureteral space. An unusual case of emphysematous urinoma complicating emphysematous pyelitis in a healthy male adult is presented in this study.

Post meningocele repair urinary ascites in a neonate--a rare presentation

A full-term female neonate with a large lumbosacral meningocele developed sudden abdominal distension and urinary retention after meningocele repair. An erect abdominal radiograph showed homogeneously opacified areas with a paucity of intestinal gas. Abdominal ultrasound revealed ascites with multiple internal echoes. With a provisional diagnosis of hollow viscus perforation, an emergency laparotomy was performed, which failed to reveal any leak from the urinary tract. However, fluid analysis confirmed the diagnosis of urinary ascites. The patient developed repeated episodes of urinary retention after catheter removal. She was started on clean intermittent catheterization (CIC) to ensure adequate bladder drainage. At 6 months of follow-up, ultrasound of the urinary tract, voiding cystourethrogram, and magnetic resonance imaging of the spine were all within normal limits. The CIC was discontinued, and the patient was observed. At present, she is voiding normally with a good stream. Failure to establish normal micturition after meningocele repair and CIC requirements suggested a neurogenic cause. Bladder rupture, secondary to spinal shock resulting in bladder atonia, could not be ruled out. The perforation (leading to urinary ascites) could be owing to bladder atonia and spinal shock rather than detrusor sphincter dyssynergia.

Fetal urinary ascites in a neonate without detectable obstructive uropathy or neurogenic bladder etiology

Fetal urinary ascites is usually secondary to an obstructive uropathy or neurogenic bladder. We present such a case in the absence of these conditions, but the presence of ipsilateral vesicoureteral reflux with Hutch diverticula. The patient was a 5-day-old boy presenting with distension of the abdomen and impairment of renal function. Tests revealed urinary ascites and renal insufficiency which spontaneously resolved after transurethral urinary drainage was established. This rare complication should be considered in neonates with high intrapelviureteric and intrarenal pressure as a result of high-grade vesicoureteral reflux with paraureteral diverticula.

Bilateral spontaneous perinephric urinomas: Case report and review of the literature

Urinoma is defined as an encapsulated collection of extravasated urine in the perirenal or paraureteral space. Urinomas in childhood are rare and usually either secondary to obstructive uropathies or due to blunt or penetrating trauma leading to injuries of the collecting system and/or ureter. Spontaneous perinephric urinomas are rare. We report the case of an 8-year-old boy with bilateral spontaneous perinephric urinomas secondary to an abnormally elevated voiding pressure with detrusor sphincter dyssynergia. The available literature on this subject is reviewed, and clinical features, pathophysiology, and treatment of this entity are discussed.

Perinephric urinoma secondary to neurogenic bladder with vesicoureteral reflux: report of an adult case

We report a case of infectious perinephric urinoma in a 73-year-old woman who had a neurogenic bladder with vesico-ureteral reflux. The patient was admitted to our emergency room with right lumbago and high fever. Ultrasounds and computed tomography demonstrated a right large perinephric cystic mass, bilateral hydronephrosis and much residual urine. Percutaneous drainage of the cystic mass was performed with an indwelling urethral catheter. The content of the mass was urine infected with Escherichia coli. Antibiotic therapy was performed successfully and we then examined the cause of the urinoma. A urodynamic study demonstrated a low-compliance small bladder and detrusor-sphincter dyssynergia. A voiding cystourethrogram revealed right grade III vesicoureteral reflux. The patient was unable to be cleared with intermittent catheterization and had an indwelling urethral catheter inserted. In 1 year, the voiding cystourethrogram showed no vesicoureteral reflux and the patient was well with no evidence of recurrent urinoma without the urethral catheter. There have been only two reported cases of urinoma caused by neurogenic bladder with vesico-ureteral reflux in children and this is the first case reported in an adult.

The role of laser-induced autofluorescence spectroscopy in bladder tumor detection. Dependence on the excitation wavelength

We assessed the ability of laser-induced autofluorescence spectroscopy to distinguish neoplastic urothelial bladder lesions from normal or nonspecific inflammatory mucosa. Three different pulsed laser excitation wavelengths were used successively: 308 nm (xenium chloride excimer laser), 337 nm (nitrogen laser) and 480 nm (coumarin dye laser). The excitation light was delivered by a specially devised multifiber catheter connected to a 1-mm core diameter silica monofiber introduced through the working channel of a standard cystoscope with saline irrigation. The captured fluorescence light was focused onto an optical multichannel analyzer detection system. Performance of this device was evaluated in 25 patients after obtaining consent and immediately before transurethral resection of a bladder tumor. Spectroscopic results were compared with histological findings. At 337- and 480-nm excitation wavelengths, the overall fluorescence intensity of bladder tumors was clearly decreased compared to normal urothelial mucosa regardless of tumor stage and grade. At the 308-nm excitation wavelength, the shape of the tumor spectra, including carcinoma in situ, was markedly different from that of normal or nonspecific inflammatory mucosa. No absolute intensity determinations were required in this situation, since a definite diagnosis could be established based on the fluorescence intensity ratio at 360 and 440 nm. This spectroscopic study could be particularly useful in designing a simplified autofluorescence imaging device for detection of occult urothelial neoplasms.