Urinary Leak

Leakage of urine can occur due to poor anastomosis, failure of suture material, distal ureteral obstruction, or unrecognized injury to the ureter distal to the anastomosis. Clinically, this can be identified by excessive and prolonged drain output or abdominal distension from urinary ascites. Confirmation can be achieved biochemically by testing the drain fluid for creatinine and comparing to serum cre-atinine. A drain fluid creatinine that is greater than the serum creatinine indicates the presence of urine.

Management of urine leak is based on maximizing drainage, and urinary diversion. In the immediate postoperative period, placement or replacement of a Foley catheter can facilitate distal drainage.

Sometimes, leakage can be exacerbated by physical contact of the drain with the anastomosis. The drain can be withdrawn a few centimeters to see if drainage subsides. If the leak is identified after stent removal, intravenous or retrograde pyelography can confirm the location of a leak and evaluate the ureteral anatomy. A stent should be replaced at that point. Prolonged catheter and stent drainage may be necessary to allow for proper healing. If the flank drain has been removed at the time of urine leak, a percutaneous drain or nephrostomy may need to be placed.

Stricture is synonymous with treatment failure.

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