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Perirenal Abscess After Partial Nephrectomy Because of Migration of Upper Calix Stone and Urine Leakage: A Case Report

Background: Nephron-sparing surgery has been shown to achieve oncological results equivalent to those of radical nephrectomy in patients with compromised renal function who have renal tumors <4 cm. However, technical difficulties and potential surgical complications remain challenges to the surge...

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Autores principales: Hung, Sheng-Chun, Chang, Li-Wen, Yang, Cheng-Kuang
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Mary Ann Liebert, Inc. 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5655837/
https://www.ncbi.nlm.nih.gov/pubmed/29098196
http://dx.doi.org/10.1089/cren.2017.0060
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author Hung, Sheng-Chun
Chang, Li-Wen
Yang, Cheng-Kuang
author_facet Hung, Sheng-Chun
Chang, Li-Wen
Yang, Cheng-Kuang
author_sort Hung, Sheng-Chun
collection PubMed
description Background: Nephron-sparing surgery has been shown to achieve oncological results equivalent to those of radical nephrectomy in patients with compromised renal function who have renal tumors <4 cm. However, technical difficulties and potential surgical complications remain challenges to the surgeon. Various factors, such as tumor size and location, collecting system invasion, and patient's expectations, are major concerns that may affect the feasibility of performing an effective partial nephrectomy. We report a patient with renal cell carcinoma who underwent open partial nephrectomy and suffered from complications of perirenal abscess because of stone migration, obstruction, and subsequence urine leakage. Case Presentation: A 63-year-old female with an incidental finding of a 4-cm renal tumor on the left kidney underwent an effective open partial nephrectomy at our institute. There were no intraoperative complications and the drainage tube was removed 3 days later. The patient visited our emergency department 1 month later with high fever. She was diagnosed with severe sepsis and perirenal abscess formation. Percutaneous nephrostomy was performed for prompt decompression. A sequential imaging study with CT and antegrade pyelography revealed one 0.5-cm stone, which migrated from the calix to proximal ureter postoperatively and subsequently caused obstruction and dramatic urine leakage. Ureteroscopic lithotripsy was performed with ureteral stenting. Postoperatively, the urinary leakage and abscess formation resolved. Conclusion: Nephron-sparing surgery is one of the most challenging procedures in the management of renal cancer. Urine leakage after partial nephrectomy may occur when a large tumor involves the collecting system. Postoperative ureteral obstruction is also a risk factor of urinary leakage. Watertight repair with a Double J catheter before operation may be required.
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spelling pubmed-56558372017-11-02 Perirenal Abscess After Partial Nephrectomy Because of Migration of Upper Calix Stone and Urine Leakage: A Case Report Hung, Sheng-Chun Chang, Li-Wen Yang, Cheng-Kuang J Endourol Case Rep Case Report Background: Nephron-sparing surgery has been shown to achieve oncological results equivalent to those of radical nephrectomy in patients with compromised renal function who have renal tumors <4 cm. However, technical difficulties and potential surgical complications remain challenges to the surgeon. Various factors, such as tumor size and location, collecting system invasion, and patient's expectations, are major concerns that may affect the feasibility of performing an effective partial nephrectomy. We report a patient with renal cell carcinoma who underwent open partial nephrectomy and suffered from complications of perirenal abscess because of stone migration, obstruction, and subsequence urine leakage. Case Presentation: A 63-year-old female with an incidental finding of a 4-cm renal tumor on the left kidney underwent an effective open partial nephrectomy at our institute. There were no intraoperative complications and the drainage tube was removed 3 days later. The patient visited our emergency department 1 month later with high fever. She was diagnosed with severe sepsis and perirenal abscess formation. Percutaneous nephrostomy was performed for prompt decompression. A sequential imaging study with CT and antegrade pyelography revealed one 0.5-cm stone, which migrated from the calix to proximal ureter postoperatively and subsequently caused obstruction and dramatic urine leakage. Ureteroscopic lithotripsy was performed with ureteral stenting. Postoperatively, the urinary leakage and abscess formation resolved. Conclusion: Nephron-sparing surgery is one of the most challenging procedures in the management of renal cancer. Urine leakage after partial nephrectomy may occur when a large tumor involves the collecting system. Postoperative ureteral obstruction is also a risk factor of urinary leakage. Watertight repair with a Double J catheter before operation may be required. Mary Ann Liebert, Inc. 2017-09-01 /pmc/articles/PMC5655837/ /pubmed/29098196 http://dx.doi.org/10.1089/cren.2017.0060 Text en © Sheng-Chun Hung et al. 2017; Published by Mary Ann Liebert, Inc. This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Case Report
Hung, Sheng-Chun
Chang, Li-Wen
Yang, Cheng-Kuang
Perirenal Abscess After Partial Nephrectomy Because of Migration of Upper Calix Stone and Urine Leakage: A Case Report
title Perirenal Abscess After Partial Nephrectomy Because of Migration of Upper Calix Stone and Urine Leakage: A Case Report
title_full Perirenal Abscess After Partial Nephrectomy Because of Migration of Upper Calix Stone and Urine Leakage: A Case Report
title_fullStr Perirenal Abscess After Partial Nephrectomy Because of Migration of Upper Calix Stone and Urine Leakage: A Case Report
title_full_unstemmed Perirenal Abscess After Partial Nephrectomy Because of Migration of Upper Calix Stone and Urine Leakage: A Case Report
title_short Perirenal Abscess After Partial Nephrectomy Because of Migration of Upper Calix Stone and Urine Leakage: A Case Report
title_sort perirenal abscess after partial nephrectomy because of migration of upper calix stone and urine leakage: a case report
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5655837/
https://www.ncbi.nlm.nih.gov/pubmed/29098196
http://dx.doi.org/10.1089/cren.2017.0060
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