Urinoma Treated with Transcatheter Arterial Embolization for Renal Artery: A Case Report

Résumé fourni par la source

Introduction: Transcatheter arterial embolization (TAE) for renal artery was generally performed for renal cancer, aneurysm, polycystic kidney disease and bleeding. Here, we report a case of urinoma with the renal abscess successfully treated with TAE. Case Description: A-79-year-old man with a past medical history of bladder cancer with total cystectomy and ileal conduit and ureterolithiasis with left ureteral stent was admitted to our hospital. He showed septic shock and disseminated intravascular coagulation (DIC) with the left renal abscess due to the dislodged left ureteral stent. He also showed acute kidney injury (AKI) and his serum creatinine was elevated to 7.37 mg/dL from baseline of 3.43 mg/dL a month before admission. He was given antibiotic for septic shock and underwent hemodialysis for AKI. He was also found to have hemorrhage from dorsal branch of the left renal artery due to DIC and performed the emergent TAE for that branch. After the TAE, we performed percutaneous drainage from the left renal abscess. However, fluid was continued to drain away from a tube inserted into the abscess. Laboratory findings showed the creatinine in the fluid was 17.09 mg/dL, and then we diagnosed as a urinoma. To treat the urinoma with infection, we performed TAE against the left renal artery to completely disrupt the renal function (Figure). After that, the fluid was dramatically decreased, the urinoma size was reduced, the abscess was fully improved, and the drainage tube was removed, though the maintenance dialysis was required. Discussion: In this case, TAE was performed for disruption of renal function to treat the urinoma. Radical nephrectomy was also considered, but it was suspected difficult due to adhesions after infection. TAE may be the one of the treatment options for the urinoma.

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