Urinoma

Severe urinary tract obstruction, particularly bladder outlet can lead to extravasation of urine and development ascites or a urinoma. These occur as complications obstruction either through rupture the calyceal fornix tear in renal parenchyma, which be identified second third trimester labor. In one study, urinomas were reported 20% cases posterior urethral valves.1Lundar L. Aksnes G. Mørkrid Emblem R. Prenatal seems preserve function boys with valves.J Pediatr Urol. 2019; 15: 241.e1-241.e7Abstract Full Text PDF Scopus (3) Google Scholar Urinomas are encapsulated collections around kidney.2Vress D. Robertson M. Paoletti Fetal urinoma: case report review literature.Australas J Ultrasound Med. 2015; 18: 38-40Crossref PubMed Some speculate that kidney gives rise urinoma serves protective mechanism for parenchyma setting increased pressure due obstruction.1Lundar Others interpret presence evidence an already compromised parenchyma.3Yitta S. Saadai P. Filly R.A. The fetal revisited.J 2014; 33: 161-166Crossref (14) On ultrasound, appears ellipsoid crescent-shaped anechoic cystic structure is adjacent (Figure). Depending on its location perinephric space, large displace anteriorly posteriorly.2Vress addition fluid collection, underlying should also observed, such bilateral hydroureteronephrosis. There may decompressed because rupture, findings thickened wall dysplasia. Urinoma strongly associated most commonly valves ureteropelvic junction (UPJ) Scholar,3Yitta differential diagnoses include lymphangioma, hemorrhagic neuroblastoma, mesenteric cyst, enteric duplication multicystic disease, polycystic tumor, ureteric duplication. It important identify other intra-abdominal structures, stomach bladder, determine exact collection accurately classify it. where lumbar spine, etiology genitourinary.3Yitta Small mistaken dilated calyx hydronephrosis; identifying mass effect cortex aid distinguishing these two diagnoses.2Vress addition, mimic urinoma; thorough evaluation compartments warranted. have been formation after trauma sustained during amniocentesis.4Miller Korzets Z. Blumenfeld Y. et al.Fetal sign dysplastic kidney.Pediatr Nephrol. 2003; 65-67Crossref (19) Relevant patient history clinical reviewed conjunction ultrasound findings. suggested genetic based recommended anomaly, usually diagnostic testing (amniocentesis chorionic villus sampling) chromosomal microarray analysis (CMA). If screening test results suggestive common aneuploidy, it reasonable initially perform karyotype fluorescence situ hybridization, reflex CMA if normal. there additional anomalies, consanguinity, family specific condition, gene panel exome sequencing sometimes useful does not detect single-gene (Mendelian) disorders. pursued, appropriate pretest posttest counseling by provider experienced complexities genomic recommended. After counseling, cell-free DNA option patients who decline aneuploidy suspected. A detailed examination focuses performed when diagnosed. Serial surveillance monitor size, progression amount amniotic initiated. Magnetic resonance imaging helpful difficult assess relationship between has evaluating Attempts at puncture drainage shown improve function.5Gorincour Rypens F. Toiviainen-Salo new literature.Ultrasound Obstet Gynecol. 2006; 28: 848-852Crossref However, successful preventing abdominal dystocia time vaginal delivery.3Yitta Prognosis depends cause gestational age presentation. reports suggests worse prognosis upper compared lower obstruction. Preserved was seen 75% valves, but only 7% UPJ obstruction.6Adorisio O. Silveri Colajacomo Bassani Rivosecchi impact perinatal function: our experience literature.J Paediatr Child Health. 2011; 47: 217-222Crossref (12) Overall, irreversible ipsilateral dysfunction 70% 80% cases.5Gorincour Scholar,6Adorisio Associated anhydramnios portends extremely poor prognosis, especially pregnancy. Spontaneous resolution possible, although uncommon, outcome. series 25 cases, 2 spontaneously resolved.3Yitta literature showed no improvement remained stable resolved, drained.5Gorincour lack requires functioning kidney, thus, growth indicate compromise. Other spontaneous normal postnatal function.7Balcom A.H. Pircon Worthington Carr utero perirenal valves.Urology. 1999; 54: 366-367Abstract Although rare prenatal finding, diagnosis one, indicates likely damage cases. This finding prompt evaluation, surveillance, follow-up.