2012-03-21-10 Urinoma, different etiologies ©Fabrice Cuillier www.TheFetus.net
Urinoma, different etiologies
* Department of Gynecology, Félix Guyon’Hospital, 97400 Saint-Denis, Ile de la Réunion, France.
Case report 1:
A 26-year-old woman, G2P1 was referred to our antenatal unit at 36 weeks for a second opinion. There was no known family history of congenital disease, in particular, no urological pathology. The patient did not take any medications. The first and the second ultrasound examinations were normal. At 32 weeks, moderate bilateral pyelectasy was demonstrated (14 mm and 8 mm). Fetal karyotype was normal (46 XY).
In our antenatal unit, ultrasound examination revealed a large left urinoma with moderate right pyelectasy (Image 1, 2). The right cortico-medullar differentiation seemed present. The urinoma hid the left kidney and stomach. Polyhydramnios was present.
Inside the bladder, we did not observe an ureterocele, but the "key-hole" sign was present (Image 3, 4). Fetal growth was normal. Posterior urethral valve diagnosis was confirmed by MRI pictures. The couple refused any further investigations, in particular any aspiration.
Image 1, 2: Left urinoma and right pyelectasy, the urinoma hid the left kidney.
Image 3, 4: "Key hole" sign suggested "Posterior urethral valve".
Image 5,6: Urinoma and bladder after aspiration
The patient delivered at 36 weeks. Renal sonography confirmed the diagnosis of left urinoma, with moderate right pyelectasy with normal cortico-medullar differentiation. Urethro-cystoscopy confirmed our diagnosis.
This case demonstrated a large urinoma caused by posterior urethral valve with left renal obstruction.
Case report 2:
A 40-year-old woman, G8P7 was referred to our antenatal unit at 28 weeks for a second opinion. There was no known family history of congenital disease, in particular urologic pathology. The patient did take any medication. The first and the second sonography were normal.
In our antenatal unit, our US investigation revealed a left urinoma (Image 7, 8). The right cortico-medullar differentiation seemed present. The bladder and the right kidney was normal with no ureterocele (Image 2). The amniotic fluid and fetal growth were normal. The diagnosis was confirmed at 30 weeks. But, the urinoma increased (Image 9,10).
We decided to perform an urinoma aspiration during amniocentesis (46 XY). A few minutes after the aspiration of 1.6 litres of fluid, we observed a slow reaccumulation, without left ureteral dilatation. We suspected an important left ureteropelvic junction obstruction (Image 11, 12).
The patient delivered at 36 weeks, because of polyhydramnios. The postnatal diagnosis confirmed the urological pathology. The left ureteropelvic junction obstruction was operated on day 2. A few days later, renal sonography revealed normal a kidney, with normal cortico-medullar differentiation.
This case demonstrated a large urinoma due to ureteropelvic junction obstruction.
Image 7, 8: Left urinoma and normal bladder without ureterocele.
Image 9, 10: Left urinoma increased in size
Image 11, 12: Left-sided collecting system dilatation suggested left ureteropelvic junction obstruction