Minimally invasive management of urinary fistula following robot-assisted partial nephrectomy: Case report

Abstract

Urinary fistulas are a known complication that can occur after partial nephrectomy, potentially causing considerable morbidity if not properly treated. The present study examines the case of a 71-year-old male patient who developed a urinary fistula six months following a robot-assisted partial nephrectomy. Initial efforts to address the fistula through the placement of a double pigtail ureteral stent proved ineffective. Subsequent interventional radiology procedures successfully achieved fistula closure by administering adhesive fibrin directly within the fistulous tract. This case highlights the importance of a multidisciplinary approach in handling post-surgical complications like urinary fistulas.

Keywords: Minimally invasive; Robot-assisted radical nephrectomy; Urinary fistula.

Fig. 1

(a, b, c) depicts CT Urography conducted during hospital readmission. Notably, contrast leakage is observed at the upper pole of the left kidney, extending both upward (b) and posteriorly behind the kidney (c).

Fig. 2

(a,b) The left kidney exhibits a double pigtail (arrow) in the pelvis, with a guidewire inserted from the lower pole via percutaneous access (asterisk), terminating in the upper pole. Additionally, there is abdominal drainage (arrow head) with a pigtail drainage at the site of urinoma collection. Contrast leakage from the upper pole is observed (star), leading to fistula formation and collection (a).Following the application of adhesive fibrin using a vascular catheter through the fistula, there was an instantaneous cessation of contrast leakage within the fistula (b).

Fig. 3

Final pyelography after removing double pigtail ureteral stent one month after nephrostomy removal confirmed the sustained absence of the urinary fistula.