What's the Diagnosis? By Dr. Michael Tom

A 44 yo M with a remote history of testicular cancer and recent retroperitoneal lymph node resection presents with sharp R sided abdominal pain. He has associated nausea, vomiting, constipation and decreased appetite. His VS are normal and his abdomen is nontender on exam. A CT abdomen/pelvis is obtained. What's the diagnosis? (scroll down for answer)


Answer: Urinoma, likely secondary to iatrogenic urethral injury

  • Ureteral injuries (though rare) are most commonly iatrogenic or secondary to penetrating trauma
  • Patients can present with fever, flank pain, sepsis, or symptoms mimicking ileus, as seen in this case
  • Diagnosis typically made with CT abdomen/pelvis w/ IV contrast with delayed phase
  • Extravasation of contrast along the course of the ureter is diagnostic for ureteral injury 
  • Complications include periureteral abscess, peritonitis, urethral stricture and urinary fistula
  • Small ureteral injuries may be amenable to stenting, while urinoma may be drained by IR
  • More extensive ureteral injuries may require ligation with delayed surgical repair


References: Gratton MC, French L. Genitourinary Trauma. In: Tintinalli JE, Stapczynski J, Ma O, Yealy DM, Meckler GD, Cline DM. eds. Tintinalli’s Emergency Medicine: A Comprehensive Study Guide, 8e New York, NY: McGraw-Hill; 2016.