Axial cut of corticomedullary phase demonstrating 4.5 cm left renal mass with RENAL Nephrometry Score of 2+2+3+p+3=10p.
Excretory phase after left partial nephrectomy, demonstrating urinary extravasation from the renorrhaphy repair.
A 66-year-old man with an incidentally discovered 4.5 cm renal mass with RENAL Nephrometry Score of 2+2+3+p+3=10p underwent a left partial nephrectomy and was found to have increased post-operative drain output that was consistent with urine.
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Risks of urinary leaks following nephron-sparing surgery range from less than 1% to more than 20% depending of various patient-related factors.1
Coronal cut of excretory phase of pre-operative CT scan demonstrating patient’s largely intraparenchymal small renal pelvis.
Tumor size, location, and anatomic complexity variables such as endophycity, nearness to collecting system, and centrality are known to affect rates of this post-operative complication.2 More recently, intraparenchymal renal pelvis anatomy was shown to be associated with marked increase of risk of urine leaks.3
The patient at hand had a high complexity renal mass (RENAL NS 10 or greater) and a greater than 50% intrarenal renal pelvis. The leak resolved spontaneously over a 4-week period.
Answer: Renal pelvis anatomy does not influence the risks of urine leak
The case was prepared by Alexander Kutikov, MD, FACS, Associate Professor of Urologic Oncology, Fox Chase Cancer Center, Philadelphia.
- Kundu SD, Thompson RH, Kallingal GJ, et al. Urinary fistulae after partial nephrectomy. BJU Int 2010;106:1042-1044.
- Simhan J, Smaldone MC, Tsai KJ, et al. Objective measures of renal mass anatomic complexity predict rates of major complications following partial nephrectomy. Eur Urol 2011;60:724-730.
- Tomaszewski JJ, Cung B, Smaldone MC, et al. Renal pelvic anatomy is associated with incidence, grade, and need for intervention for urine leak following partial nephrectomy. Eur Urol [Epub ahead of print].