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2019-10-27  Bilateral urinoma  © Imane Benchiba  www.TheFetus.net

Bilateral urinoma
Imane BenchibaZineb Chaquchaq , Nissrine Mamouni , Sanaa Errarhay, Chahrazed Bouchikhi , Abdelaziz Banani
Obstetrics and Gynecology I - HASSAN II University Hospital – Fez- Morocco

Introduction
A urinoma is a fluid mass formed by extravasated urine encapsulated in the perirenal fascia. It is also known as pseudohydronephrosis or pararenal pseudocyst.

Case report
a 26‐year‐old primigravida in whom routine ultrasound examination at 26 weeks' gestation showed a male fetus with isolated bilateral renal pelvic dilatation  No ureteral dilatation Oblique coronal fetal ultrasound showing bilateral perirenal fluid collections (arrows) compressing and displacing the kidneys. Both kidneys are hyperechoic suggesting renal dysplasia.
       

Discussion
Fetal ultrasound examination enables us to diagnose and follow the progress of obstructive uropathies, including the occurrence of fetal urinomas preservation of renal function is less effective when urinomas occur in utero. 
The factors necessary for its formation had been suspected for some time, and are now well established: (1) existing renal malfunction; (2) an underlying obstruction; and (3) rupture of the collecting system.
The differential diagnosis includes hydronephrosis, cystic renal disease,duplication of the intrarenal collecting system, cystic renal tumor, cystic lymphangioma, cystic neuroblastoma, mesenteric cyst and enteric duplication cyst.
The prognosis was better in cases of PUV than in UPJO It and a very poor functional prognosis and the subsequent life‐threatening risk (from, for example, oligohydramnios or pulmonary hypoplasia) in cases of bilateral urinomas or urinoma in a single kidney.
In‐utero puncture only appears to be justified in cases where the urinoma has a mass effect on adjacent major structures (especially the contralateral kidney), or in the case of probable dystocia. If a puncture is performed, a recurrence after aspiration is highly likely and repeat punctures or the initial installation of a more permanent shunt could be offered.

Conclusions
Although the precise causes of urinomas are still unknown, this review shows that in the event of a fetal urinoma, the probability of a non-functional dysplastic ipsilateral kidney lies at around 80%. In-utero puncture only appears to be justified in cases where fluid accumulation has mass effects on adjacent major structures.

References
1. Razzaboni G. Ricerche sperimentali sulla pseudo‐idronephrosi. Archivio Italiano di Chirurgia 1922; 6: 365. Google Scholar
2.Aizenstein RI, Owens C, Sabnis S, Wilbur AC, Hibbeln JF, O'Neil HK. The perinephric space and renal fascia: review of normal anatomy, pathology, and pathways of disease spread. Crit Rev Diagn Imaging 1997; 38: 325– 367. CASPubMedWeb of Science®Google Scholar
3.Miller M, Korzets Z, Blumenfeld Y, Pomeranz M, Aviram R, Rathaus V, Pomeranz A. Fetal urinoma as a sign of dysplastic kidney. Pediatr Nephrol 2003; 18: 65– 67. CrossrefPubMedWeb of Science®Google Scholar
4.Mandell J, Platiel HJ, Peters CA, Benacerraf BR. Prenatal findings associated with a unilateral nonfunctioning or absent kidney. J Urol 1994; 152: 176– 178. CrossrefCASPubMedWeb of Science®Google Scholar
5.Chen CP, Shih SL, Liu FF, Jan SW, Tsai TC, Chang PY, Lan CC, Chen CP. In utero urinary bladder perforation, urinary ascites, and bilateral contained urinomas secondary to posterior urethral valves: clinical and imaging findings. Pediatr Radiol 1997; 27: 3– 5.CrossrefPubMedWeb of Science®Google Scholar
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