Trans-renal ureteral occlusion for the management of persistent intraperitoneal bladder leak

Surgical repair is the recommended management for intraperitoneal bladder perforation. In certain cases, repair may be unsuccessful or non-feasible, resulting in refractory urine leak. Ileal conduit formation remains an alternative, howeve it may not be suitable for all patients. In this case, an intraperitoneal bladder perforation occurred during TURBT. Laparoscopic repair was unsuccessful, as were bilateral nephrostomies in controlling the urine extravasation. The patient was not a candidate for surgical urinary diversion. We occluded both ureters using stents, microvascular plugs and embolisation coil and glue. Post intervention the urine leak resolved and the patient was discharged with nephrostomies in-situ.