A case report: urinoma as initial presenting sign of bladder malignancy

The role of point-of-care ultrasound in the assessment of pelvic urine leakage and diagnosis of urinoma

BACKGROUND

Urinoma, a rare condition resulting from urine leakage due to trauma to the kidney, bladder, or urethra, is typically diagnosed using enhanced computed tomography urogram with delayed imaging. This report presents two cases of urinoma likely caused by overdistention of the renal pelvis following excessive fluid intake and the presence of a ureteral stone.

CASE PRESENTATION

We present two cases of 36-year-old and 38-year-old patients who presented with flank pain. point-of-care ultrasound (POCUS) played a pivotal role in identifying perinephric fluid in Morrison's space and the splenorenal space, respectively. These ultrasound findings guided further investigations, leading to definitive diagnoses via abdominal pelvic CT scans. Treatment involved prophylactic antibiotics and the successful placement of a double J stent into the renal pelvis over the wire under fluoroscopic guidance, which resulted in significant clinical improvement for both patients.

CONCLUSIONS

This study demonstrates the rare occurrence of urinoma from urolithiasis, the use of POCUS in expediting diagnosis and treatment, and the importance of interpreting sonographic images in the correct clinical setting.

Urinoma as the result of a 3mm stone in ipsilateral ureter: A rare case report

Leakage from the kidney, ureter, bladder, and urethra, which mainly occur due to trauma, forms urinoma. The best tool for diagnosis of urinoma is enhanced-computed tomography with delayed imaging. Apart from injury, ureteral stone can induce urinoma, however, it is rare. Herein, we report a case with urinoma, which probably formed as a result of overdistention of renal pelvis after a large amount of fluid intake (about 3 L) in a short period of time (about an hour) in the presence of a 3mm stone in ipsilateral ureter.

Urinoma presenting as an abscess in an immunocompromised host: a case report

INTRODUCTION

This case report illustrates the relatively rare occurrence of a urinoma masquerading as an abscess in a patient with refractory recurrent non-Hodgkin's lymphoma. Although urinomas have been reported after urinary instrumentation, our case was confounded by a concurrent pleural effusion, an immunocompromised host, and clinical appearance and subsequent incision and drainage that was consistent with an abscess. Although not the first case reported in the literature, the constellation of findings in our patient demonstrates the importance of including urinoma in the differential diagnosis of patients with flank mass.

CASE PRESENTATION

Here we report a case of a retroperitoneal fluid collection found in an immunocompromised 65-year-old Caucasian woman. She had recurrent non-Hodgkin's lymphoma and was neutropenic when the collection was found. Drainage of the fluid demonstrated infection, but the case was complicated by increasing fluid production and the development of an ipsilateral pleural effusion. Despite pleural drainage, the abscess output continued to be high. A computed tomography scan demonstrated fluid collection around the renal calices suggestive of rupture; analysis of the fluid was suggestive of a urinoma. The etiology, pathogenesis, and treatment of urinomas in such patients are discussed.

CONCLUSIONS

Urinomas can present in patients who have had urinary tract instrumentation or trauma, but can occur in other hosts. Patients with hematologic malignancy can develop malignant or sympathetic pleural effusions and are at risk for skin and soft tissue infections. Clinicians caring for immunocompromised patients, particularly hematologists, oncologists, and transplant clinicians, should be aware of this potential complication because rapid identification and attempt at correction are important to optimize outcome.