Subcapsular Splenic Urinoma and Splenorenal Fistula: A New Complication of Percutaneous Nephrolithotomy.
Abstract
Background: Splenic urinoma has not been previously reported as a complication of percutaneous
nephrolithotomy (PNL). Case Presentation: A 46-year-old Caucasian male underwent PNL for two large left renal stones. Surgery
was performed in prone split-leg position, with access obtained through combined fluoroscopic
guidance and direct ureteroscopic observation of the targeted calix. The tract was
dilated to 30F using a pressure balloon, and complete clearance of stones was obtained
through a combination of rigid and flexible nephroscopy, as well as antegrade ureteroscopy.
The patient was left with a Double-J ureteral stent on a string for removal in 1 week.
After overnight observation, his hemoglobin, white blood cell count, and renal function
were normal and thus he was discharged home. The day after stent removal, he presented
to the emergency department with abdominal pain, was found to have mild left hydronephrosis
on CT, and was discharged on 1 week of antibiotics. One week later he re-presented
with worsening abdominal pain and was found to have an elevated creatinine and a white
blood cell count of 21 × 109/L. On contrasted CT with delayed images, an 18 cm splenic fluid collection was seen
with a fistulous connection to the left kidney collecting system. He underwent emergent
stent placement and improved clinically without drainage of the urinoma. A renal ultrasonography
1 month after stent placement confirmed resolution of the splenic urinoma, so the
stent was removed at 1 month. Follow-up CT 1 month after stent removal was normal
without any evidence of fistula or urinoma recurrence. Conclusion: This is the first report of a subcapsular splenic urinoma and splenorenal fistula
post-PNL. Ureteral stent placement was sufficient for drainage and to resolve the
complication.
Type
Journal articleSubject
kidney traumanephrolithiasis
percutaneous nephrolithotomy complication
percutaneous nephrolitothomy
urinoma
urolithiasis
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https://hdl.handle.net/10161/25546Published Version (Please cite this version)
10.1089/cren.2017.0085Publication Info
Cone, Eugene B; Jibara, Ghalib; Wollin, Daniel; & Preminger, Glenn M (2017). Subcapsular Splenic Urinoma and Splenorenal Fistula: A New Complication of Percutaneous
Nephrolithotomy. Journal of endourology case reports, 3(1). pp. 134-137. 10.1089/cren.2017.0085. Retrieved from https://hdl.handle.net/10161/25546.This is constructed from limited available data and may be imprecise. To cite this
article, please review & use the official citation provided by the journal.
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Show full item recordScholars@Duke
Eugene Cone
House Staff
Ghalib Jibara
House Staff
Glenn Michael Preminger
James F. Glenn, M.D. Distinguished Professor of Urology
1. Minimally invasive management of urologic diseases 2. Minimally invasive management
of renal and ureteral stones 3. Medical management of nephrolithiasis 4. Bioeffects
of shock wave lithotripsy 5. Basic physics of shock wave lithotripsy 6. Intracorporeal
lithotripsy for stone fragmentation 7. Minimally invasive management of urinary tract
obstruction, including ureteropelvic junction obstruction and ureteral strictures
8. Enhanced imaging modalities f
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