Acute Kidney Injury With Unilateral Urinoma Secondary To Malignant Ureteral Obstruction in Stage IIIB Cervical Cancer: A Case Report

Abstract

Objective: Acute kidney injury (AKI) is a common complication in cancer patients and malignant ureteral obstruction (MUO) is one of the most important postrenal complications in the most advanced pelvic malignancies. MUO causes urinoma very rarely reported in the literature. Case Presentation: A 38-year-old woman with advanced cervical cancer has developed obstructive acute kidney injury and is on hemodialysis. FIGO stage IIIB cervical cancer has bilateral malignant ureteral obstruction, bilateral hydroureteronephrosis and large left perirenal urinoma. She underwent left double-J stent placement and percutaneous drainage of the urinoma and biopsy showed necrotic inflammatory tissue without malignancy. Despite decompression, renal function was gradually impaired and she was kept on hemodialysis for the next 10 weeks. Ten weeks later she was readmitted with acute-on-chronic kidney disease with severe electrolyte and metabolic complications, anemia and pneumonia in her lungs. Repeat imaging revealed persistent left perirenal urinoma. The patient was treated and had clinical and biochemical improvement. Conclusion: Unilateral perirenal urinoma is a rare complication of MUO in advanced cervical cancer patients. Early diagnosis of cancer, appropriate urinary decompression and multidisciplinary management are critical to prevent life-threatening renal complications and to optimise cancer treatment. Objective: Acute kidney injury (AKI) is a common complication in cancer patients and malignant ureteral obstruction (MUO) is one of the most important postrenal complications in the most advanced pelvic malignancies. MUO causes urinoma very rarely reported in the literature. Case Presentation: A 38-year-old woman with advanced cervical cancer has developed obstructive acute kidney injury and is on hemodialysis. FIGO stage IIIB cervical cancer has bilateral malignant ureteral obstruction, bilateral hydroureteronephrosis and large left perirenal urinoma. She underwent left double-J stent placement and percutaneous drainage of the urinoma and biopsy showed necrotic inflammatory tissue without malignancy. Despite decompression, renal function was gradually impaired and she was kept on hemodialysis for the next 10 weeks. Ten weeks later she was readmitted with acute-on-chronic kidney disease with severe electrolyte and metabolic complications, anemia and pneumonia in her lungs. Repeat imaging revealed persistent left perirenal urinoma. The patient was treated and had clinical and biochemical improvement. Conclusion: Unilateral perirenal urinoma is a rare complication of MUO in advanced cervical cancer patients. Early diagnosis of cancer, appropriate urinary decompression and multidisciplinary management are critical to prevent life-threatening renal complications and to optimise cancer treatment.