Rectus Urinoma Leading to Abscess Following Urethral Perforation From Self-Catheterization: A Case Report

Urinomas are an accumulation of urine in the perirenal or paraureteral space due to urinary tract leakage. Stimulation of an inflammatory response results in the formation of a thick wall that encapsulates the urine. Etiologies of urinomas include trauma, surgery, or spontaneous occurrence. Complications when untreated vary and include peritonitis, fibrosis, abscess formation, and septic shock. We present a 52-year-old male with a neurogenic bladder who developed a rectus urinoma from the thorax to the scrotum. This likely developed from urethral trauma from intermittent self-catheterization. The patient received antibiotic therapy and percutaneous drainage catheters were placed in the rectus and pelvis, resolving the urinoma. We conclude that patients who perform intermittent self-catheterization may be more susceptible to formation of urinomas due to improper catheter usage. The intricate fascial connections between the pelvis and abdomen make proper interventions for suspected urinary tract injury crucial in patients who self-catheterize.

Long-term results of transurethral endoscopic excision using the holmium laser for urethral perforation of synthetic slings

OBJECTIVE

This study reports on the long-term results of transurethral endoscopic excision using the Holmium laser (TEEH) for large urethral perforation (UP; defined as involving one-quarter or more of the urethral circumference) from synthetic slings.

METHODS

Charts of women treated with TEEH for large UP were reviewed. TEEH was performed using a 365-μm laser fiber passed inside an open-ended ureteral catheter positioned in a holmium laser enucleation of the prostate (HoLEP) sheath to stabilize the laser fiber. Data extracted included patient demographics, clinical presentations, surgical details, postoperative functional outcomes and complications, and any secondary repairs.

RESULTS

From 2011 to 2016, 12 women underwent TEEH. The mean interval between sling placement and first TEEH was 47 months (range 10-161 months). The types of slings included transvaginal tape (n = 2), transobturator tape (n = 4), mini-invasive (n = 4), and Solyx (1), or were not specified (n = 1). The mean number of TEEH procedures was 1.6 (range 1-3), and the mean length of initial treatment was 40 min (range 15-79 min), with subsequent treatments <30 min. Mean follow-up time was 43 months (range 14-70). Resolution of UP by TEEH alone was achieved in 6 patients, with 2 requiring multiple TEEH. Six patients underwent secondary vaginal mesh sling excision alone or with an associated repair including 2 small distal urethrovaginal fistulas.

CONCLUSION

TEEH is a minimally invasive procedure that can avoid a more complex initial urethral reconstruction and should be considered for treating large UP. Secondary repairs for residual small UP or associated lower urinary tract symptomatology may be necessary and patients should be counseled accordingly.