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Glozman T, Kooner S, Kostowniak C, Pacheco R, Zhang Y, Dumas CL, Chopra A. A rare case of infected urinothorax. Respir Med Case Rep 2024; 47:101989. [PMID: 38318225 PMCID: PMC10840361 DOI: 10.1016/j.rmcr.2024.101989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 01/10/2024] [Accepted: 01/16/2024] [Indexed: 02/07/2024] Open
Abstract
Urinothorax is a rare cause of pleural effusion. Infected urinothorax is even rarer. Here we present a case of infected urinothorax from renal mass causing obstructive uropathy. Patient improved with pleural drainage and a multidisciplinary approach of treatment between team involving urologist and pulmonologist. This case highlights the complexity in the diagnosis and management of infected urinothorax.
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Affiliation(s)
- Thomas Glozman
- Department of Medicine, Albany Medical Center 43 New Scotland Avenue, Albany, NY, USA
| | - Simrin Kooner
- Department of Medicine, Albany Medical Center 43 New Scotland Avenue, Albany, NY, USA
| | - Christian Kostowniak
- Department of Medicine, Albany Medical Center 43 New Scotland Avenue, Albany, NY, USA
| | - Robert Pacheco
- Department of Radiology, Albany Medical Center, 43 New Scotland Avenue, Albany, NY, USA
| | - Yikun Zhang
- Department of Medicine, Albany Medical Center 43 New Scotland Avenue, Albany, NY, USA
| | - Camille L. Dumas
- Department of Radiology, Albany Medical Center, 43 New Scotland Avenue, Albany, NY, USA
| | - Amit Chopra
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Albany Medical Center 16 New Scotland Avenue, Albany, NY, USA
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Vergne F, Le Mao R, Simonin L, Descourt R, Couturaud F, Barnier A, Tromeur C. [A very unusual pleural presentation]. Rev Mal Respir 2018; 35:567-570. [PMID: 29778619 DOI: 10.1016/j.rmr.2017.10.665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Accepted: 10/26/2017] [Indexed: 10/16/2022]
Abstract
Urinothorax refers to the presence of urine in the pleural space. Urinothorax is an infrequent and underdiagnosed pathology, with few cases reported, and these often suspected only with hindsight. It is usually a transudative pleural effusion. We report a case of urinothorax presenting as a purulent pleural effusion. Management of the urinothorax required antibiotics and surgical unblocking of the urinary tract. Currently, no test is available to confirm the diagnosis. The ratio of serum creatinine/pleural creatinine could suggest the presence of urinothorax but this parameter needs to be validated by complementary studies. Urinothorax should be suspected in the context of pleural effusion occurring after a recent urologic surgery.
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Affiliation(s)
- F Vergne
- Service de pneumologie, hôpital la Cavale-Blanche, CHRU de Brest, boulevard Tanguy-Prigent, 29200 Brest, France
| | - R Le Mao
- Service de pneumologie, hôpital la Cavale-Blanche, CHRU de Brest, boulevard Tanguy-Prigent, 29200 Brest, France
| | - L Simonin
- Service de pneumologie, hôpital la Cavale-Blanche, CHRU de Brest, boulevard Tanguy-Prigent, 29200 Brest, France
| | - R Descourt
- Service de pneumologie, hôpital la Cavale-Blanche, CHRU de Brest, boulevard Tanguy-Prigent, 29200 Brest, France
| | - F Couturaud
- Service de pneumologie, hôpital la Cavale-Blanche, CHRU de Brest, boulevard Tanguy-Prigent, 29200 Brest, France; EA3878, CIC-Inserm 1412, hôpital de la Cavale-Blanche, CHRU de Brest, 29200 Brest, France
| | - A Barnier
- Service de pneumologie, hôpital la Cavale-Blanche, CHRU de Brest, boulevard Tanguy-Prigent, 29200 Brest, France; EA3878, CIC-Inserm 1412, hôpital de la Cavale-Blanche, CHRU de Brest, 29200 Brest, France
| | - C Tromeur
- Service de pneumologie, hôpital la Cavale-Blanche, CHRU de Brest, boulevard Tanguy-Prigent, 29200 Brest, France; EA3878, CIC-Inserm 1412, hôpital de la Cavale-Blanche, CHRU de Brest, 29200 Brest, France.
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Toubes ME, Lama A, Ferreiro L, Golpe A, Álvarez-Dobaño JM, González-Barcala FJ, San José E, Rodríguez-Núñez N, Rábade C, Lourido T, Valdés L. Urinothorax: a systematic review. J Thorac Dis 2017; 9:1209-1218. [PMID: 28616270 DOI: 10.21037/jtd.2017.04.22] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND The characteristics of patients with urinothorax (UT) are poorly defined. METHODS A systematic review was performed searching for studies reporting clinical findings, pleural fluid (PF) characteristics, and the most effective treatment of UT. Case descriptions and retrospective studies were included. RESULTS The review included 78 studies with a total of 88 patients. Median age was 45 years, male/female ratio was 1.6:1 and in 76% of cases the etiology was trauma. Pleural effusion (PE) was predominantly unilateral (87%) and occupied over 2/3 of the hemithorax in most cases (64.4%). PF was straw-colored (72.7%) or hematic (27.3%) with urine-like odor in all cases. PF was transudate in 56.2% of cases (18/32) and among 14 exudates (43.8%), 3 were concordant exudates, 1 protein-discordant and 10 LDH-discordant, with lymphocyte (44.4%) and neutrophil (38.5%) predominance. The PF/serum (PF/S) creatinine ratio was >1 in all cases except one (97.9%). The diagnosis was established on the basis of PF/S creatinine ratio >1 (56.6%), urinary tract contrast extravasation (12%), abnormal computed tomography (8.4%), laparotomy findings (6%), and association of obstructive uropathy with PE (6%). The outcome was favorable (74/77; 96.1%) when treatment was direct towards the uropathy (alone or associated with thoracentesis/thoracic drainage). Outcome was unfavorable in the 15 patients who were only treated with thoracentesis/thoracic drainage. CONCLUSIONS UT is usually traumatic, unilateral, and PF does not have a specific pattern or cellularity predominance, with a PF/S creatinine ratio almost always >1. Treatment should include the uropathy, with or without PF evacuation.
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Affiliation(s)
- María E Toubes
- Department of Pulmonology, University Clinical Hospital of Santiago de Compostela, Santiago de Compostela, Spain
| | - Adriana Lama
- Department of Pulmonology, University Clinical Hospital of Santiago de Compostela, Santiago de Compostela, Spain
| | - Lucía Ferreiro
- Department of Pulmonology, University Clinical Hospital of Santiago de Compostela, Santiago de Compostela, Spain.,Interdisciplinary Research Group in Pulmonology, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - Antonio Golpe
- Department of Pulmonology, University Clinical Hospital of Santiago de Compostela, Santiago de Compostela, Spain.,Interdisciplinary Research Group in Pulmonology, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - José M Álvarez-Dobaño
- Department of Pulmonology, University Clinical Hospital of Santiago de Compostela, Santiago de Compostela, Spain.,Interdisciplinary Research Group in Pulmonology, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - Francisco J González-Barcala
- Department of Pulmonology, University Clinical Hospital of Santiago de Compostela, Santiago de Compostela, Spain.,Interdisciplinary Research Group in Pulmonology, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - Esther San José
- Interdisciplinary Research Group in Pulmonology, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain.,Department of Clinical Analysis, University Clinical Hospital of Santiago de Compostela, Santiago de Compostela, Spain
| | - Nuria Rodríguez-Núñez
- Department of Pulmonology, University Clinical Hospital of Santiago de Compostela, Santiago de Compostela, Spain
| | - Carlos Rábade
- Department of Pulmonology, University Clinical Hospital of Santiago de Compostela, Santiago de Compostela, Spain
| | - Tamara Lourido
- Department of Pulmonology, University Clinical Hospital of Santiago de Compostela, Santiago de Compostela, Spain
| | - Luis Valdés
- Department of Pulmonology, University Clinical Hospital of Santiago de Compostela, Santiago de Compostela, Spain.,Interdisciplinary Research Group in Pulmonology, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
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Austin A, Jogani SN, Brasher PB, Argula RG, Huggins JT, Chopra A. The Urinothorax: A Comprehensive Review With Case Series. Am J Med Sci 2017; 354:44-53. [PMID: 28755732 DOI: 10.1016/j.amjms.2017.03.034] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Revised: 02/17/2017] [Accepted: 03/29/2017] [Indexed: 01/08/2023]
Abstract
Urinothorax is an uncommon thoracic complication of genitourinary (GU) tract disease, which is most frequently caused by obstructive uropathy, but may also occur as a result of iatrogenic or traumatic GU injury. It is underrecognized because of a perceived notion as to the rarity of the diagnosis and the absence of established diagnostic criteria. Urinothorax is typically described as a paucicellular, transudative pleural effusion with a pleural fluid/serum creatinine ratio >1.0. It is the only transudate associated with pleural fluid acidosis (pH < 7.40). When the pleural fluid analysis demonstrates features of a transudate, pH <7.40 and a pleural fluid/serum creatinine ratio >1.0, a confident clinical diagnosis of urinothorax can be established. A technetium 99m renal scan can be considered a confirmatory test in patients who lack the typical pleural fluid analysis features or fail to demonstrate evidence of obstructive uropathy that can be identified via conventional radiographic modalities. Management of a urinothorax requires a multidisciplinary approach with an emphasis on the correction of the underlying GU tract pathology, and once corrected, this often leads to a rapid resolution of the pleural effusion.
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Affiliation(s)
- Adam Austin
- Department of Medicine, Albany Medical College, Albany, New York.
| | - Sidharth Navin Jogani
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Albany Medical College, Albany, New York
| | - Paul Bradley Brasher
- Department of Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Rahul Gupta Argula
- Department of Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - John Terrill Huggins
- Department of Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Amit Chopra
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Albany Medical College, Albany, New York
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Casallas A, Castañeda-Cardona C, Rosselli D. Urinothorax: Case report and systematic review of the literature. Urol Ann 2016; 8:91-4. [PMID: 26834411 PMCID: PMC4719522 DOI: 10.4103/0974-7796.164851] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Urinothorax, the presence of urine in the pleural space, is a rare cause of pleural effusion, usually associated with obstructive uropathy, or urinary trauma. We present the case of a 3 year-old boy and a systematic review of the literature of the 44 cases encountered. After resection of a Wilm's tumour in the right kidney our patient presented acute respiratory distress associated with radiographically confirmed pleural effusion. With the initial diagnosis of pneumonia or malignant pleural effusion, a closed thoracotomy was performed. The liquid obtained suggested urine, which was confirmed by the laboratory. Cystoscopy with retrograde pyelography detected a fistula on the posterior wall of the right kidney. The report of cases worldwide is low, probably due to its low incidence but also to underdiagnosis. Respiratory symptoms are not always present and urological symptoms usually predominate. Diagnosis requires a high degree of clinical suspicion and is confirmed by the main biochemical marker: The ratio >1.0 pleural fluid creatinine and creatinine serum.
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Affiliation(s)
- Alexander Casallas
- Department of Clinical Epidemiology and Biostatistics, Clínica Infantil Colsubsidio, Pontificia Universidad Javeriana, Bogota, Colombia
| | - Camilo Castañeda-Cardona
- Department of Clinical Epidemiology and Biostatistics, Pontificia Universidad Javeriana, Bogota, Colombia
| | - Diego Rosselli
- Department of Clinical Epidemiology and Biostatistics, Pontificia Universidad Javeriana, Bogota, Colombia
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Batura D, Haylock-Vize P, Naji Y, Tennant R, Fawcett K. Management of iatrogenic urinothorax following ultrasound guided percutaneous nephrostomy. J Radiol Case Rep 2014; 8:34-40. [PMID: 24967012 DOI: 10.3941/jrcr.v8i1.1424] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
A 64 year-old male with metastatic prostate adenocarcinoma presented with bilateral hydronephrosis and renal impairment. Bilateral percutaneous nephrostomy drainage followed by ante-grade stenting was done. Shortly afterwards, the patient developed an extensive left-sided pleural effusion. His serum creatinine rose and he became anuric. Emergency pleural aspiration and later, pleural drainage were performed. Pleural aspirate was diagnostic of urinothorax and non contrast CT scan demonstrated a left reno-pleural fistula. The right stent was removed cystoscopically. The left stent could not be removed cystoscopically and was replaced in an ante grade manner through a fresh percutaneous renal approach. This led to cessation of pleural fluid accumulation. The patient was discharged with bilateral ureteric stents and normal renal function. A month later, he had normal renal function, no hydronephrosis and normal chest x-rays.
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Affiliation(s)
- Deepak Batura
- Department of Urology, Northwick Park Hospital, London, UK
| | | | - Yaser Naji
- Department of Interventional Radiology, Northwick Park Hospital, London, UK
| | - Rachel Tennant
- Department of Respiratory Medicine, Northwick Park Hospital, London, UK
| | - Katherine Fawcett
- Department of Respiratory Medicine, Northwick Park Hospital, London, UK
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Abstract
Pleural effusion caused by post-traumatic extravasation of urine from the abdominal cavity to the pleural cavity (urothorax) is an uncommon complication following traumatic injury. To the authors' knowledge, this is the first report of a case of traumatic urothorax in a dog presented with pleural and abdominal urine effusion. Combined urothorax and uroabdomen should be included in the differential-diagnosis list for dogs with recent trauma and a bicavitary effusion. The diagnosis can be confirmed by elevated creatinine concentrations in both effusates, compared to its serum concentration.
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Affiliation(s)
- S Klainbart
- Koret School of Veterinary Medicine, Robert H. Smith Faculty of Agriculture, Food and Environment, The Hebrew University of Jerusalem, Rehovot, Israel
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Abstract
PURPOSE OF REVIEW The presence of urine in the pleural space (urinothorax) is a rarely recognized cause of pleural effusion. To date, only 58 cases have been reported. In this article the features of urinothorax are analyzed, and clinical and biochemical characteristics are reviewed in order to propose a classification, founded on pathogenic criteria, that will be useful in achieving the diagnosis. RECENT FINDINGS Recently reported cases of urinothorax provide a more detailed description of the biochemical characteristics that allow a better understanding of this entity. SUMMARY Urinothorax can be divided into two categories: (1) obstructive urinothorax, due to bilateral obstructive uropathy; and (2) traumatic urinothorax, due to unilateral traumatic injury of the urinary system, mostly iatrogenic. In patients with urinothorax, the pleural effusion usually has the biochemical characteristics of a transudate, with a pH lower than 7.30 and a pleural fluid/serum creatinine ratio higher than 1. These characteristics are not always present, however, and individually are shared by a significant number of pleural effusions of different etiology.
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Tortora A, Casciani E, Kharrub Z, Gualdi G. Urinothorax: an unexpected cause of severe dyspnea. Emerg Radiol 2006; 12:189-91. [PMID: 16738932 DOI: 10.1007/s10140-006-0468-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2005] [Accepted: 12/16/2005] [Indexed: 10/24/2022]
Abstract
We report an unusual cause of the pleural effusion due to extravasation of urine from the retroperitoneal space into the thoracic cavity. In our case, the urinoma occurred owing to obstructing urinary tract lesion due to opaque stone. Although rare, urinothorax should be considered when pleural effusion occurs in patients with urinary tract obstruction accompanied by retroperitoneal urinoma.
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Affiliation(s)
- Alessandra Tortora
- Department of Emergency Radiology, Policlinico Umberto I, viale del Policlinico 155, Roma, 00161, Italy.
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10
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Wang IK, Chuang FR, Chang HY, Lin CL, Yang CT. Acute pyelonephritis associated with transudative pleural effusion in a middle-aged woman without urinary tract obstruction. Med Princ Pract 2006; 15:309-11. [PMID: 16763401 DOI: 10.1159/000092997] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2005] [Accepted: 10/26/2005] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To describe a case of acute pyelonephritis associated with pleural effusion. CLINICAL PRESENTATION AND INTERVENTION A 39-year-old female non-smoker who had Escherichia coli bacteremia due to acute pyelonephritis, developed bilateral transudative pleural effusions during hospitalization. She was successfully treated with intravenous antibiotic therapy. Follow-up chest radiographs revealed complete resolution of the bilateral pleural effusions. CONCLUSION Though quite rare, pleural effusion is a potential complication of acute pyelonephritis. The exact pathogenesis of transudative pleural effusion is unknown, but the effusion may resolve spontaneously when infection is adequately controlled.
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Affiliation(s)
- I-Kuan Wang
- Department of Internal Medicine, Chang Gung Memorial Hospital, Chiayi, and Chang Gung University, Taiwan, ROC
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11
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Lee CC, Fang CC, Chou HC, Tsau YK. Urinothorax associated with VURD syndrome. Pediatr Nephrol 2005; 20:543-6. [PMID: 15711949 DOI: 10.1007/s00467-004-1755-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2004] [Revised: 10/18/2004] [Accepted: 10/19/2004] [Indexed: 11/27/2022]
Abstract
VURD syndrome is a congenital genitourinary anomaly combining posterior urethral V alves, U nilateral vesicoureteral R eflux and renal D ysplasia. We report on a case of VURD syndrome presenting with acute renal failure and respiratory distress syndrome due to urinothorax. Urinothorax is a rarely reported complication of obstructive uropathy, but has not been linked to VURD syndrome. The diagnosis of urinothorax was confirmed by demonstration of a pleural fluid to serum creatinine ratio greater than one. Without tube thoracotomy drainage, urinothorax resolved rapidly after urinary catheterization and the renal recovery was also excellent after primary valve ablation. We discuss the diagnosis and management of urinothorax and the possible protective effect of urinoma, urinothorax, and unilateral vesicoureteral reflux on the renal function. We consider that urinothorax and urinoma may be deemed to be the extension of the clinical spectrum of VRUD syndrome. Excellent renal prognosis in our case also favors the protective effect provided by the buffer of pressure from unilateral vesicoureteral reflux, urinoma and urinothorax.
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Affiliation(s)
- Chien-Chang Lee
- Department of Emergency Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
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Abstract
Hydrothorax was identified in a 14-year-old Siamese cat with a pre-existent perinephric pseudocyst. The pleural fluid was classified as a low-protein transudate. Intrapseudocystic scintigraphy confirmed a direct communication between the pseudocyst and the pleural space. The hydrothorax resolved following pseudocystectomy and unilateral nephrectomy, demonstrating that the pseudocyst caused the hydrothorax.
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Affiliation(s)
- M Rishniw
- Department of Veterinary Medicine and Epidemiology, University of California, Davis 95616-8747, USA
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13
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Affiliation(s)
- B J Chanatry
- Department of Critical Care Medicine, Dartmouth Hitchcock Medical Center, Lebanon, NH
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Seiler RK, Filmer RB, Reitelman C. Traumatic disruption of the ureteropelvic junction managed by ileal interposition. J Urol 1991; 146:392-5. [PMID: 1856938 DOI: 10.1016/s0022-5347(17)37803-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The use of ileal interposition in the management of a patient with delayed diagnosis of traumatic disruption of the ureteropelvic junction is presented. The unusual presentation of this problem, potential options in reconstructing the ureter and successful outcome are discussed.
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Affiliation(s)
- R K Seiler
- Department of Urology, Children's Hospital of Michigan, Wayne State University, Detroit
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Passas V, Vasilakos P, Brountzos E, Grilias D. An unusual encapsulated collection of urine (urinoma) in an infant with vesicoureteral reflux. Pediatr Radiol 1987; 17:422-4. [PMID: 3306594 DOI: 10.1007/bf02396623] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
We describe an unusual case of encapsulated collection of urine (urinoma) in a 7-month-old female infant. The clinical diagnosis was urinary tract infection. The retrograde cysto-urethrogram revealed grade III vesicoureteral reflux, which we believe was the cause of the urinoma. The investigation was completed with isotope and ultrasound studies. High pressure reflux was the cause of the urine extravasation in the perirenal space.
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Abstract
Urinothorax should be considered when pleural effusion occurs in patients with urinary tract obstruction accompanied by retroperitoneal urinoma. This recommendation is based on our experience with 4 cases and a review of the literature. In 2 patients urinary obstruction was owing to retroperitoneal fibrosis secondary to malignancy, including one who had a neuroectodermal undifferentiated small round cell tumor and the other who had a metastatic epithelial neoplasm. In the 2 other patients urinary obstruction resulted from a failed ureteroneocystotomy following renal allograft transplantation. All 4 patients had a urinoma, which may be a predisposing factor to urinothorax.
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17
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Redman JF, Arnold WC, Smith PL, Seibert JJ. Hypertension and urino-thorax following an attempted percutaneous nephrostomy. J Urol 1982; 128:1307-8. [PMID: 7154193 DOI: 10.1016/s0022-5347(17)53474-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Leung FW, Williams AJ, Oill PA. Pleural effusion associated with urinary tract obstruction: support for a hypothesis. Thorax 1981; 36:632-3. [PMID: 7314037 PMCID: PMC471660 DOI: 10.1136/thx.36.8.632] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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Abstract
Urinary tract obstruction may produce a pleural effusion detectable by chest x-ray film. This uncommon finding must be differentiated from intrathoracic and intraperitoneal causes of pleural effusion, including intrathoracic metastases when a malignant tumor is the cause of the urinary tract obstruction.
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Abstract
During the past decade some urologists and radiologists have doubted the existence of posterior urethral valves. It has been suggested that the primary lesion in patients thought to have urethral valves is bladder neck obstruction. During the past seven years we have seen an average of three new cases of posterior urethral valves per annum. In all cases the valves themselves, not the bladder neck, obstructed the urethra. The urologist may miss valves at urethroscopy, but use of the new fibreoptic endoscope has improved his chances of seeing them. Posterior urethral valves may not be demonstrated radiologically if the radiologist does not use a rapid recording device or if the patient does not micturate forcefully during micturating cystourethrography. Failure to detect the valves may lead to an erroneous diagnosis of bladder neck obstruction.
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