Percutaneous endoscopic management of persistent urine leak after partial nephrectomy

Area of Science:

• Urology
• Minimally Invasive Surgery
• Nephrology

Background:

• Nephron-sparing surgery, specifically partial nephrectomy (PN), is increasingly utilized for renal mass management.
• Urine leak is a recognized complication of PN that can necessitate further intervention if initial treatments are unsuccessful.

Observation:

• Two patients experienced persistent urine leaks post-PN, unresponsive to conservative therapies including ureteral stents, Foley catheters, and percutaneous nephrostomy (PCN).
• One patient developed a urine leak from an upper-pole calix, while the second had a nephrocutaneous fistula from an upper-pole remnant.

Findings:

• A novel percutaneous approach involving direct access, dilation, and nephrostomy tube placement successfully resolved an upper-pole urine leak.
• Percutaneous endoscopy with fulguration of the leaking calix through a dilated PCN tract effectively treated a nephrocutaneous fistula.

Implications:

• This minimally invasive percutaneous technique offers a viable solution for managing complex urine leaks after partial nephrectomy.
• Successful resolution of urine leaks without further intervention or impact on renal function is achievable with this approach.