[Left flank tumor of fluctuating size in a 5-week-old boy: perirenal urinoma caused by urethral valves].
BACKGROUND
Flank swelling and pseudotumors of the kidney are unusual manifestations of obstructive uropathies in small children. Our case illustrates typical problems and briefly reviews management options.


METHODS
A 5-week-old boy presented with a large, palpable urinoma due to posterior urethral valves. Sonography and voiding cystourethrogram led to the diagnosis and immediate suprapubic transcutaneous urinary diversion was performed. However, the urinoma did not resolve. Thus, in addition to suprapubic urinary diversion, indirect drainage - instead of percutaneous puncture - was performed by retrograde insertion of a double-J catheter. Urethral valves were resected 4 weeks later and follow-up demonstrated an uneventful further development with normal renal function as assessed by regular ultrasound studies, a repeat cystourethrogram and a renal scan.


CONCLUSIONS
Perirenal urinomas may be the first symptom in patients with posterior urethral valves. Drainage via double-J stenting offers a promising alternative to percutaneous puncture. A renoprotective "pop-off" mechanism by which intrarenal pressure may be relieved is discussed.
von Schnakenburg
C
C
Zentrum für Kinderheilkunde und Jugendmedizin, Universitätsklinikum Freiburg. christian.schakenburg@uniklinik-freiburg.de
Dorn
A
A
Jacobi
C
C
Fisch
D
D
Pohl
M
M
Frankenschmidt
A
A
D002408:Catheters, Indwelling; D003559:Cystostomy; D005119:Extravasation of Diagnostic and Therapeutic Materials / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D012422:Rupture, Spontaneous; D014463:Ultrasonography; D014515:Ureteral Diseases / Q000175:diagnosis* / Q000628:therapy; D014524:Urethral Obstruction / Q000150:complications / Q000151:congenital* / Q000175:diagnosis / Q000601:surgery; D053584:Urinoma / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D014567:Urography; D014718:Vesico-Ureteral Reflux / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy