Ultrasound-guided drainage of perirenal and periureteral urine collections

Thirty patients with perirenal and periureteral collections were evaluated. The reasons for these collections were after open surgery on the kidney in 11, open surgery on the ureter in 10, percutaneous nephrostolithotomy in 2, after renal transplantation in 5, and after ureteroscopy in 2. The presenting symptoms and signs included flank pain in 12, urine leakage in 5, fever in 5, masses in the iliac fossa in 5, and flank mass in 3. Ultrasound-guided single-step drainage of these collections was done using 10-12 F catheters. Ultrasound-guided single-step percutaneous nephrostomy (PCN) was done prior to drainage of the collection in seven patients in whom ultrasound revealed back pressure changes in their renal units. Pigtail catheters (7-10 F) were used for PCN. The aspirated fluid was clear urine in 12 cases and turbid in 18. The amount of fluid drained ranged from 150-500 mL immediately after the procedure. We used color Doppler sonography to map the site of puncture. No complications were encountered after drainage. The period of drainage varied from 1 week to 37 days. Further intervention was needed in 12 cases due to development of ureteric stricture in 7, prolonged leakage in 3 (one after transplantation, one after ureterocolic anastomosis, and one after ureterolithotomy), and residual stones in 2. Double-J stenting was done in four cases. We conclude that ultrasound-guided drainage of perirenal and periureteral collections is a safe, rapid, and easy method of treatment and should eliminate the need for exploration to drain these collections. Whenever backpressure exists in the renal unit, ultrasound-guided PCN should be done prior to drainage of the collection.