Percutaneous endoscopic management of persistent urine leak after partial nephrectomy.

PURPOSE

As nephron-sparing surgery becomes more commonly used for the management of renal masses, the incidence of complications unique to this procedure will increase. Urine leak after partial nephrectomy (PN) is a common occurrence that can be difficult to manage if conservative measures fail. We describe our approach for persistent urine leaks after PN.

PATIENTS AND METHODS

Two patients presented with urine leaks after PN. After an upper-pole heminephrectomy, fever developed in the first patient. CT showed an intra-abdominal fluid collection, and percutaneous drainage confirmed a urine leak with persistently high outputs from an upper-pole calix. Conservative management, including ureteral stent, Foley catheter, and percutaneous nephrostomy (PCN) drainage failed. The calix was then directly accessed percutaneously, dilated to 30F, and a 22F nephrostomy tube was placed through the tract into the renal pelvis. The urine leak quickly resolved. The second patient had a lower pole heminephrectomy, and a urine leak with nephrocutaneous fistula from the posterior aspect of the upper-pole remnant developed. Again, conservative measures failed before percutaneous endoscopy. The PCN tract was dilated to 30F, and 3 weeks later the leaking calix was fulgurated through the tract with a flexible ureteroscope.

RESULTS

Both patients had complete resolution of urine leaks, stable creatinine levels, and required no further intervention.

CONCLUSIONS

Urine leak after PN remains a complex problem if conservative measures are unsuccessful. We describe a novel technique to percutaneously manage persistent urine leak after PN through a minimally invasive approach.