An Unusual Case of Metastatic Prostate Cancer Presenting as a Massive Urinoma

Urinoma formation as the first manifestation of carcinoma prostate is uncommon and has been reported only twice in the literature. We report a case of prostatic carcinoma in an elderly man who first presented in the emergency department with left-sided abdominal pain. His radiological investigations revealed a left-sided urinoma with dilatation of the entire ureter and an enlarged prostate with areas of varied intensity especially in the peripheral zone of the left lobe. In view of raised serum prostate-specific antigen (PSA) (155 ng/ml), a prostate biopsy was done, which showed features of adenocarcinoma (Gleason score 5+5). He was managed with pigtail drainage of urinoma, followed by double J stenting of the left ureter, and later underwent bilateral orchidectomy to reduce tumor burden, being metastatic disease. The stent was removed at a later date.