Delayed presentation of urinoma after radiofrequency ablation-assisted laparoscopic partial nephrectomy

Purpose: To examine the outcomes and complications of thermal ablation-assisted laparoscopic partial nephrectomy (LPN). Patients and Methods: Radiofrequency ablation (RFA)-assisted laparoscopic partial nephrectomy was employed in 16 consecutive renal masses with a mean size of 3.0 cm over 12 months. The indications were primarily adjacent bowel, hilar location, or both. After RFA, the renal mass was laparoscopically excised and examined pathologically. Results: The mean operative treatment time was 99 minutes. The estimated blood loss was 121 mL, and no patient required a blood transfusion. Urinoma was diagnosed in three patients at an average of 13 days postoperatively and resolved with conservative management or ureteral stent placement. Conclusions: Radiofrequency ablation-assisted LPN provides effective hemostasis and, in the short term, cancer control. In this setting, urinoma presents as ipsilateral flank pain I to 2 weeks after surgery. The proposed mechanism for the delayed presentation is thermal injury to the collecting system, although an unrecognized direct collecting-system injury is possible. Conservative management, ureteral stent placement, or both led to resolution of all of the urinomas.