Subcapsular Splenic Urinoma and Splenorenal Fistula: A New Complication of Percutaneous Nephrolithotomy

Background: Splenic urinoma has not been previously reported as a complication of percutaneous nephrolithotomy (PNL). Case Presentation: A 46-year-old Caucasian male underwent PNL for two large left renal stones. Surgery was performed in prone split-leg position, with access obtained through combined fluoroscopic guidance and direct ureteroscopic observation of the targeted calix. The tract was dilated to 30F using a pressure balloon, and complete clearance of stones was obtained through a combination of rigid and flexible nephroscopy, as well as antegrade ureteroscopy. The patient was left with a Double-J ureteral stent on a string for removal in 1 week. After overnight observation, his hemoglobin, white blood cell count, and renal function were normal and thus he was discharged home. The day after stent removal, he presented to the emergency department with abdominal pain, was found to have mild left hydronephrosis on CT, and was discharged on 1 week of antibiotics. One week later he re-presented with worsening abdominal pain and was found to have an elevated creatinine and a white blood cell count of 21 × 10(9)/L. On contrasted CT with delayed images, an 18 cm splenic fluid collection was seen with a fistulous connection to the left kidney collecting system. He underwent emergent stent placement and improved clinically without drainage of the urinoma. A renal ultrasonography 1 month after stent placement confirmed resolution of the splenic urinoma, so the stent was removed at 1 month. Follow-up CT 1 month after stent removal was normal without any evidence of fistula or urinoma recurrence. Conclusion: This is the first report of a subcapsular splenic urinoma and splenorenal fistula post-PNL. Ureteral stent placement was sufficient for drainage and to resolve the complication.