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Year : 2015  |  Volume : 52  |  Issue : 3  |  Page : 473--474

Bladder cancer presenting with spontaneous subcapsular urinoma of kidney

NK Goyal, A Goel, V Singh, SN Sankhwar 
 Department of Urology, C. S. M. Medical University (Upgraded King George's Medical College), Lucknow, Uttar Pradesh, India

Correspondence Address:
A Goel
Department of Urology, C. S. M. Medical University (Upgraded King George's Medical College), Lucknow, Uttar Pradesh

How to cite this article:
Goyal N K, Goel A, Singh V, Sankhwar S N. Bladder cancer presenting with spontaneous subcapsular urinoma of kidney.Indian J Cancer 2015;52:473-474

How to cite this URL:
Goyal N K, Goel A, Singh V, Sankhwar S N. Bladder cancer presenting with spontaneous subcapsular urinoma of kidney. Indian J Cancer [serial online] 2015 [cited 2022 Dec 2 ];52:473-474
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A urinoma is a well-defined fluid collection formed by encapsulation of extravasated urine. It usually follows an obstructing ureteral calculus.[1] Other important causes include renal trauma and iatrogenic injuries.[2] Unusual causes include obstructive uropathy caused by posterior urethral valves, gynecological malignancies, gravid uterus, pelvi-ureteric junction obstruction, and vascular extrinsic compression. However, tumor obstruction leading to forniceal rupture and urinoma formation is very rare.

A 55-year-old woman presented with history of painless gross hematuria, urinary frequency and urgency for 3 months. There was no history of abdominal pain, ureteral colic, trauma, or previous surgery. Her physical examination revealed a smooth surfaced mass in the left flank region. Abdominal ultrasonography showed bilateral hydro-ureteronephrosis, a well-defined subcapsular fluid collection of left kidney, and a large bladder mass, which was confirmed to be a solid-looking growth at the trigone of bladder on cystoscopy. Bilateral ureteral orifices could not be visualized due to large growth. Her renal function parameters were normal. Contrast enhanced computed tomography (CECT) [Figure 1] and [Figure 2] confirmed a large (13.5 × 9.0 × 7.5 cm) subcapsular urinoma of left kidney, bilateral hydro-ureteronephrosis, and an enhancing bladder mass at the trigone. Ultrasound-guided percutaneous aspiration and left-sided nephrostomy drainage with a pigtail catheter resolved the urinoma. Histopathology of transurethrally resected tumor demonstrated high-grade, muscle invasive, transitional cell carcinoma (T2 G3). Patient underwent radical cystectomy and ileal conduit diversion and is doing well.{Figure 1}{Figure 2}

Three essential factors, responsible for urinoma formation, are continued renal function, rupture of the collecting system, and distal obstruction.[3] Most commonly, it is associated with obstructing ureteral calculi. This acute onset obstruction leads to sudden rise in intra-pelvic pressure causing rupture of the collecting system.[1] The extravasated urine sets a low-grade inflammation and lipolysis, followed by encapsulation of the urine by fibroblastic activity.[3] Urinomas are usually not associated with chronic obstruction.[4] Forniceal rupture following malignancy is relatively uncommon due to gradually progressive hydronephrosis.[5] In the largest reported series of 108 patients, only 8.3% of urinomas were caused by malignant ureteral compression, but none of them was caused by a bladder tumor.[1] An extensive literature search revealed only two such cases of bladder tumor presenting with urinoma formation. In year 1976, Twersky et al. reported the first case of urinoma caused by a bladder tumor.[4] Second patient had a high-grade bladder tumor with ureteric orifice involvement.[3] The pathophysiology of forniceal rupture caused by bladder tumor is difficult to understand. First, a bladder growth generally takes time to grow, so it does not lead to an acute onset obstruction, leading to sudden rise of intra-pelvic pressure. Secondly, urine usually passes through the ureteric orifices that are entirely overgrown by the tumor and even directly infiltrated by the tumor. Thirdly, as it is a very distal obstruction, considerable pressure on the renal collecting system should have been compensated by the entity of reno-ureteral unit. Another peculiar aspect of this case is a large size, well-localized sub-capsular urinoma with no perinephric extension or stranding, which usually accompanies this entity because of surrounding lipolysis.


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2McInerney D, Jones A, Roylance J. Urinoma. Clin Radiol 1977;28:345-51.
3Ali Khan S, Desai PG, Jayachandran S, Smith NL. Urinoma: A rare presentation of carcinoma of the bladder. Urol Int 1985;40:97-9.
4Twersky J, Twersky N, Phillips G, Coppersmith H. Peripelvic extravasation, urinoma formation and tumor obstruction of the ureter. J Urol 1976;116:305-7.
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