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.
