PMC7545418_01
(a) Preoperative CT scan showing the lesion at the inferiomedial aspect of the right kidney. (b) Delayed phase CT scan demonstrating the urine leak from the site of partial nephrectomy. (c) Postoperative plain X-ray showing the JJ stent in position.
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fig1
Preoperative CT scan showed a heterogeneously enhancing mass at the inferior pole of the right kidney suggestive of neoplastic lesion (PADUA score 8) (Figure 1(a)) for which he underwent transperitoneal laparoscopic partial nephrectomy with 25 minutes warm ischemia time and the surgery was uneventful. One day later, he developed high-grade fever, and CT scan showed minimal urine leak from the site of the partial nephrectomy (Figure 1(b)). Therefore, 26 cm, 6 FR stent was inserted easily (Figure 1(c)) and a Foley's catheter was fixed.
(a) Retrograde pyelography showing a fistulous tract between the upper ureter and the inferior calyceal system. The blind end of the renal pelvis is also seen. (b) Simultaneous retrograde and antegrade pyelography following the insertion of the nephrostomy tube.
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fig2
A trial to insert a JJ stent failed and retrograde pyelography showed normal ureter up to approximately 3 cm below the ureteropelvic junction which had a blind end and there was a fistula between the upper ureter and lower calyceal system (ureterocalyceal fistula) (Figures 2(a) and 2(b)).