Percutaneous Application of Fibrin Sealant in Surgically Recalcitrant Urinomas Following Oncocytoma Resection

Purpose: To present two cases of successful treatment of recalcitrant urinomas after partial nephrectomy for oncocytomas

Materials and Methods: Presented are two patients with recalcitrant urinomas despite diversion therapy following partial nephrectomy for oncocytomas. Both patients were successfully treated with percutaneous application of fibrin sealant via a sheath at the time of percutaneous perinephric drain removal. Patient 1 was treated for bilateral urinomas despite 4 months of complete urinary diversion. A fibrin sealant (TISSEEL; Baxter, Deerfield, IL) was injected. Under fluoroscopy, a right perinephric drain was removed over a wire, and an 8-Fr sheath was inserted. Through the sheath, a delivery catheter was positioned in proximity to the lower pole of the remaining right kidney at the presumed area of urine leak. Under fluoroscopic guidance, a total of 40 mL of sealant was delivered using a pull-back technique, and the sheath was removed. After 2 months, the procedure was repeated on the left kidney with injection of 80 mL of sealant into the small cavity after perinephric drain removal. Follow-up computed tomography (CT) demonstrated resolution of the urinomas. The patient’s creatinine stabilized at 2.04 mg/dL after all interventions. Patient 2 was treated for urinoma after 3 months of optimal diversion. The patient’s perinephric tube output remained at 100 mL/day. The decision was made to inject a fibrin sealant (TISSEEL) to treat the recalcitrant urinoma. Under fluoroscopy, the left perinephric drain was removed over a wire, and an 8-Fr sheath was inserted in the perinephric space. Through the sheath and using the same technique as previously described, a total of 50 mL of sealant was delivered, and the sheath was removed. Follow-up CT showed resolution of the urinoma. The patient’s creatinine stabilized at 1.58 mg/dL after all procedures.

Results: Complete resolution of all three recalcitrant urinomas treated by fibrin sealant injection.

Conclusions: In summary, the reported cases show the efficacy of fibrin sealant injection for recalcitrant urinomas after partial nephrectomies for oncocytomas when performed by a well-trained interventional radiologist. Although urinary diversion followed by surgery remains the preferred therapy based on its proven efficacy and safety, percutaneous application of fibrin sealant could be considered as an alternative in the correct clinical context.