Urinoma is defined as an encapsulated collection of extravasated urine(1). In urinary ascites the capsule is the peritoneum. It usually occurs following renal trauma. One of the iatrogenic causes, is urinary system trauma during voiding cystourethrography (VCUG) (2).

A 4½-month-old boy was referred to our clinic with the complaint of progressive abdominal distention for one week before admission. Additionally he developed oliguria and was anuric for two days. During ultra-sonographic examination of the urinary system due to growth retardation and hypocalcemia, left renal grade 1 pelvicaliceal ectasy was detected. Twenty days before his admission VCUG was done to reveal any underlying disorder. In the following period a significant increase was observed in the abdominal circumference.

On admission the boy was anuric with severe abdominal distention. He was minimally dyspneic with no respiratory sounds at the lower thoracal segments on auscultation. Cardiovascular examination was normal with a normal blood pressure value for his age. No peripheral edema was observed. Urinary catheterization revealed no urine output during the following hours.

The ascites fluid was cloudy yellow in appearance due to fibrin particles and a high polymorphonuclear leucocyte count (>1000/mm3). Its density was 1020 and its biochemical profile was as follows: Urea: 110.7 mg/dL, Creatinine: 3.3 mg/dL, Na: 125.5 mEq/L, it was noted that the urea and the creatinine values were much higher than the blood values (Urea: 82.3 mg/dL, Creatinine: 1.68 mg/dL).

The patient had disproportionately low blood urea and creatinine levels for anuria of two days duration but had much higher urea and creatinine values in the ascites fluid compared to serum values. We suspected urine leakage into the peritoneal cavity. On computerized tomography (CT) of the abdomen a defect in the anterior wall of the urinary bladder was revealed. The contrast material given into the bladder was observed leaking into the peritoneal cavity under X- ray proving a rupture in the bladder wall. Re-evaluating the past clinical history we found out that the VCUG performed 20 days before admission was the only possible cause of this rupture.

As soon as the rupture was diagnosed the bladder wall was mended.

Complications in VCUG are infrequent. Most common ones are traumas to urethra and urinary bladder. Urinary bladder rupture, allergic reactions to the contrast material and knotting of the catheter inside the bladder may also be seen(2-5). As long as most of the bladder is retroperitoneally placed, urine generally leaks retroperitoneally following urinary bladder ruptures.

Halit Çam,
Istanbul University,
Cerrahpasa Medical Faculty,
Department of Pediatrics,
Istanbul University,
Turkey.
E-mail: [email protected]

1. Ito S, Ikeda M, Asanuma H, Shishido S, Nakai H, Honda M. A giant urinoma in a neonate without obstructive uropathy. Pediatr Nephrol 2000; 14: 831-832.

2. Gaisie G, Bender TM. Knotting of urethral catheter within bladder: An unusual complication in cystourethrography. Urol Radiol 1983; 5: 271-272.

3. De Vries SH, Klinjn AJ, Lilien MR, De Jong TP. Development of renal function after neonatal urinary ascites due to obstructive uropathy. J Urol 2002; 168: 675-678.

4. Ghali AM, El Malik EM, Ibrahim Al, Ismail G, Rashid M. J Trauma. Ureteric injuries: Diagnosis, management and outcome. 1999; 46: 150-158.

5. Gonzalvez Pinera J, Fernandez Cordoba M, Vidal Company A. Intravesical knot of Foley catheter: Unusual complication of cystourethrography in children. An Esp Pediatr 2000; 53: 601-603.