ABSTRACT. Urinary fistula is an acknowledged complication of partial nephrectomy. We describe a case of a urinary fistula that failed to respond to conventional treatment and the subsequent use of percutaneous HystoacrylH glue to achieve its resolution.
Case reportA 57-year-old woman underwent an uncomplicated right lower pole partial nephrectomy for Fuhrman grade 3 pT1NxMx clear cell renal cell carcinoma, through a right loin 11th rib incision. At outpatient review meeting 1 month after discharge, she was well and reported only mild discomfort in the region of the wound. Renal CT after 1 year demonstrated no evidence of disease recurrence; however, a 10 cm diameter urinoma was identified anterior to the right kidney compressing the pelviureteric junction (PUJ) and upper ureter (Figure 1). Her renal function was normal.After multidisciplinary discussion, percutaneous drainage of the perinephric collection was performed, which resulted in continuous daily urine drainage of 20-100 ml that persisted for the next month, despite the added intervention of a right nephrostomy 2 weeks after drain insertion (Figure 2). The nephrostomy was deliberately placed through the point of leakage. A right retrograde pyelogram was performed and confirmed a lower pole urinary fistula and a PUJ obstruction. A right JJ ureteric stent was sited; however, urine drainage continued from the lower pole leak.As the urinary fistula had not responded to conventional management and nephrostomy was not a tolerable long-term option for the patient, the following options were considered: