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E-Poster Submission Deadline
Please prepare and upload your E-Poster no later than March 14, 2026 11.59PM CET. After this date, you will no longer be able to prepare and upload your E-poster and it will not be displayed and accessible on the congress website.
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Urinoma is a rare but potentially life-threatening collection of extravasated urine, often resulting from trauma or iatrogenic ureteral injury. Urinoma is unique condition that refers to extravasation of urine from a disruption of the urinary collecting system at any level from the calix to the urethra. We report a case of 45-year-old female who developed a giant right-sided urinoma following hysterectomy due to iatrogenic ureteral stricture and obstruction.
A 45-year-old woman presented with right upper abdominal pain and a palpable mass two weeks after hysterectomy for uterine myoma. She developed oliguria and acute kidney injury (AKI) secondary to post-renal obstruction. Laboratory results revealed markedly elevated urea (217 mg/dL) and creatinine (15.3 mg/dL). Abdominal CT contrast showed right hydronephrosis grade IV, hydroureter, and a 13 × 11 × 15 cm encapsulated cystic mass consistent with a giant urinoma. Ureteral stenting attempts failed due to distal ureteral obstruction. Renal function partially recovered with hemodialysis and supportive management; however, progressive mass enlargement required surgical intervention. Intraoperatively, a necrotic and fibrotic right ureter confirmed iatrogenic stricture. A radical right nephrectomy with urinoma evacuation was performed. Postoperatively, renal function normalized (creatinine 0.9 mg/dL), and the patient was discharged with satisfactory recovery. showed right hydronephrosis grade IV, hydroureter, and a 13 × 11 × 15 cm encapsulated cystic mass consistent with a giant urinoma. Ureteral stenting attempts failed due to distal ureteral obstruction. Renal function partially recovered with hemodialysis and supportive management; however, progressive mass enlargement required surgical intervention. Intraoperatively, a necrotic and fibrotic right ureter confirmed iatrogenic stricture. A radical right nephrectomy with urinoma evacuation was performed. Postoperatively, renal function normalized (creatinine 0.9 mg/dL), and the patient was discharged with satisfactory recovery.
Urinoma is an uncommon complication characterized by urine extravasation into perirenal or retroperitoneal spaces, often secondary to ureteral trauma or obstruction. In this case, the ureteral stricture likely resulted from an iatrogenic injury during hysterectomy, leading to increased backpressure, calyceal rupture, and urine leakage. CT imaging remains the gold standard for diagnosis, accurately delineating the extent of the collection conservative management may suffice for small urinomas; however, nephrectomy is indicated in cases with severe obstruction, non-functional kidney, or infection risk. This case proposes a novel clinical hypothesis: delayed recognition of micro-ischemic ureteral injury post-hysterectomy may lead to late-onset giant urinoma despite transient renal recovery.
Postoperative ureteral injury should always be suspected in patients presenting with flank mass and renal dysfunction after pelvic surgery. Early CT evaluation and multidisciplinary management are crucial to prevent irreversible renal loss. Total nephrectomy remains a life-saving intervention in giant urinoma with irreversible obstruction.
