Delayed presentation of urinoma after radiofrequency ablation-assisted laparoscopic partial nephrectomy.
OBJECTIVE
To examine the outcomes and complications of thermal ablation-assisted laparoscopic partial nephrectomy (LPN).


METHODS
Radiofrequency ablation (RFA)-assisted laparoscopic partial nephrectomy was employed in 16 consecutive renal masses with a mean size of 3.0 cm over 12 months. The indications were primarily adjacent bowel, hilar location, or both. After RFA, the renal mass was laparoscopically excised and examined pathologically.


RESULTS
The mean operative treatment time was 99 minutes. The estimated blood loss was 121 mL, and no patient required a blood transfusion. Urinoma was diagnosed in three patients at an average of 13 days postoperatively and resolved with conservative management or ureteral stent placement.


CONCLUSIONS
Radiofrequency ablation-assisted LPN provides effective hemostasis and, in the short term, cancer control. In this setting, urinoma presents as ipsilateral flank pain 1 to 2 weeks after surgery. The proposed mechanism for the delayed presentation is thermal injury to the collecting system, although an unrecognized direct collecting-system injury is possible. Conservative management, ureteral stent placement, or both led to resolution of all of the urinomas.
Oefelein
Michael G
MG
Spokane Urology, Spokane, Washington 99204, USA. mgoefelein@comcast.net
D000328:Adult; D000368:Aged; D002292:Carcinoma, Renal Cell / Q000473:pathology / Q000601:surgery*; D017115:Catheter Ablation / Q000009:adverse effects* / Q000379:methods; D005500:Follow-Up Studies; D006801:Humans; D007680:Kidney Neoplasms / Q000473:pathology / Q000601:surgery*; D010535:Laparoscopy; D008875:Middle Aged; D009392:Nephrectomy / Q000009:adverse effects* / Q000379:methods; D011183:Postoperative Complications; D012189:Retrospective Studies; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D014556:Urine; D014570:Urologic Diseases / Q000000981:diagnostic imaging / Q000209:etiology*