Journal of Postgraduate Medicine
 Open access journal indexed with Index Medicus & ISI's SCI  
Users online: 4507  
Home | Subscribe | Feedback | Login 
About Latest Articles Back-Issues Articlesmenu-bullet Search Instructions Online Submission Subscribe Etcetera Contact
 :: Next article
 :: Previous article 
 :: Table of Contents
 ::  Similar in PUBMED
 ::  Search Pubmed for
 ::  Search in Google Scholar for
 ::  Article in PDF (97 KB)
 ::  Citation Manager
 ::  Access Statistics
 ::  Reader Comments
 ::  Email Alert *
 ::  Add to My List *
* Registration required (free) 

  IN THIS Article
 ::  Case History
 ::  Discussion
 ::  References
 ::  Article Figures

 Article Access Statistics
    PDF Downloaded141    
    Comments [Add]    
    Cited by others 3    

Recommend this journal


Year : 2004  |  Volume : 50  |  Issue : 3  |  Page : 217-218

Emphysematous urinoma

R G Stone Clinic, Mumbai, India

Date of Submission30-Sep-2003
Date of Decision29-Nov-2003
Date of Acceptance11-Apr-2004

Correspondence Address:
Pankaj N Maheshwari
R G Stone Clinic, Mumbai
Login to access the Email id

Source of Support: None, Conflict of Interest: None

PMID: 15377811

Rights and PermissionsRights and Permissions

How to cite this article:
Maheshwari PN, Trivedi N N, Kausik V B, Parmar V P. Emphysematous urinoma . J Postgrad Med 2004;50:217-8

How to cite this URL:
Maheshwari PN, Trivedi N N, Kausik V B, Parmar V P. Emphysematous urinoma . J Postgrad Med [serial online] 2004 [cited 2023 Sep 22];50:217-8. Available from:

Ureteroscopy is a commonly performed endourological procedure. Although complications after ureteroscopy are rare (less than 2%), urinary infection is the commonest problem. Emphysematous pyelonephritis (EPN) is a rare life-threatening infection characterised by the presence of gas within the renal parenchyma, collecting system and perinephric tissue. Here, immediate nephrectomy is often considered essential. Such an emphysematous infective process may occur in collections of urine (urinoma) that occur secondary to a urinary leak.[1] We describe a case of emphysematous infection of a post-ureteroscopy urinoma with interesting radiological findings, a so-called 'emphysematous urinoma'.

 :: Case History Top

A 68-year-old diabetic lady presented three weeks after ureteroscopy for left ureteric calculus with left flank pain, fever, altered sensorium, hypotension (BP<90mm of Hg) and leucocytosis of 25,000. Bedside ultrasonography and later a computerised tomography revealed a large subcapsular urinoma with multiple air-fluid levels along the posterior aspect of the kidney. Renal parenchyma and pelvi-calyceal system were otherwise normal [Figure - 1] and [Figure - 2].

Under local anaesthesia, sonography-guided percutaneous aspiration and pigtail drainage of urinoma was done; 150 millilitres of purulent fluid with gas was drained. Culture of the aspirated fluid grew E coli.

Patient improved with parenteral antibiotics, hydration, glycaemia control and percutaneous drainage. Antibiotic cover included cefoperazone (2 g twice a day), amikacin (500 mg twice a day) and metronidazole (500 mg thrice a day). The urinoma cavity was lavaged daily with diluted gentamicin and povidone iodine solution. The lavage was performed to keep the drainage catheter patent, for local antibiotic effect and for the sclerosant effect of iodine. Contrast study was done on alternate days to monitor the size of the cavity. Pigtail catheter was removed after nine days once the cavity collapsed. Patient had a smooth postoperative course.

 :: Discussion Top

This case report illustrates an uncommon complication of urine leak after ureteroscopy, leading to emphysematous urinoma. The diagnosis was made by computed tomography and was treated with drainage and aggressive antibiotics.

EPN is a severe renal infection, more common in elderly diabetic patients often associated with the destruction of the renal parenchyma.[1]-[3] It is also described in association with renal cell carcinoma, end-stage renal disease and after renal transplant.[4] The commonest offending organism is E coli; rarely Klebsiella pneumoniae and Candida, have been described.

The sequence of events that led to the present condition can only be speculated. Presumably there was a subcapsular collection due to fornicial tear caused by the high irrigation-pressures during ureteroscopy. This collection could have been infected with E coli. The high ambient glucose concentration in the collection with poor blood supply (conditions thought to be conducive to gas formation) might have led to the picture of emphysematous urinoma.

A potential source of gas in the urinoma could be a fistulous communication with a loop of bowel. This source was excluded by contrast study. The other potential source of gas could have been the catheterisation of the urinary tract. The absence of gas in the collecting system makes this less likely.

Earlier literature suggests nephrectomy as the only option for fulminant EPN. However, this itself is a hazardous intervention in a septic, unstable patient with circulatory or liver failure, with mortality of about 40%. Currently the trend is towards conservative treatment with antibiotics, relief of obstruction and percutaneous drainage when necessary.[5] Huang has classified EPN into four classes.[3] Class 1 and 2 where the gas is limited to the collecting system or the parenchyma, had excellent results with renal conservation. Extensive infection (Class 3 and 4), especially when associated with thrombocytopenia, acute renal function impairment, disturbance of consciousness, or shock, needed nephrectomy. In our patient, the conservative strategy worked well and led to uneventful recovery.

 :: References Top

1.Rao PS, Ravindran A, Elsamaloty H, Modi KS. Emphysematous urinoma in a renal transplant patient. Am J Kidney Dis 2001;38:E29.  Back to cited text no. 1  [PUBMED]  
2.Patterson JE, Andriole VT. Bacterial urinary tract infections in diabetes. Infect Dis Clin North Am 1997;11:735-50.   Back to cited text no. 2  [PUBMED]  
3.Huang JJ, Tseng CC. Emphysematous pyelonephritis: Clinico-radiological classification, management, prognosis, and pathogenesis. Arch Intern Med 2000;160:797-805.   Back to cited text no. 3  [PUBMED]  [FULLTEXT]
4.Lin CH, Huang JJ, Liu HL, Lee SY, Hsieh RY, Tseng CC. Renal cell carcinoma complicated by emphysematous pyelonephritis in a non-diabetic patient with renal failure. Nephron 2002;92:227-9.  Back to cited text no. 4  [PUBMED]  [FULLTEXT]
5.Ku JY, Kim ME, Lee NK, Park NK. Emphysematous pyelonephritis recovered by ureteral stenting in a functionally solitary kidney. Urol Int 2002;69:321-2.  Back to cited text no. 5    


[Figure - 1], [Figure - 2]

This article has been cited by
1 Renal pelvis rupture due to lower ureter stone: Case report and review of the literature | [Üreter alt uç taşιna baǧlι böbrek pelvis rüptürü: Olgu sunumu ve yayιnlarιn deǧerlendirilmesi]
Huri, E., Akgül, T., Yücel, Ö., Polat, O., Germiyanoǧlu, C.
Turk Uroloji Dergisi. 2008; 34(4): 499-501
2 Rupture of the renal pelvis due to ureteral stone | [Üreter taşιna baǧlι böbrek pelvis rüptürü]
Kiraç, M., Akyüz, S., Üre, I., Batur, A.F., Çelik, M., Tunç, L.
Turk Uroloji Dergisi. 2007; 33(3): 369-371
3 Rupture of the renal pelvis complicating a renal colic: report of a case
Ferri E, Casoni GLC, Morabito G, et al.


Print this article  Email this article
Previous article Next article
Online since 12th February '04
© 2004 - Journal of Postgraduate Medicine
Official Publication of the Staff Society of the Seth GS Medical College and KEM Hospital, Mumbai, India
Published by Wolters Kluwer - Medknow