Dextranomer/Hyaluronic Acid Injection in the Treatment of Ureteral Stump Urine Leak after Nephrectomy

Introduction: A refluxing ureteral stump after nephrectomy resulting in an urinoma is an uncommon occurrence. We describe a novel technique to obstruct the refluxing ureteral stump after Foley catheter drainage failed. Material and Methods: A 52-year-old man who developed a persistent ureteral stricture after a Boari flap ureteroneocystostomy resulting in compromised function of the kidney, underwent a laparoscopic simple nephrectomy. Intraoperative instillation of methylene blue in the bladder did not show extravasation at the transected ureteral end. Postoperatively patient developed a urinoma that failed an adequate trial of Foley catheter drainage of the bladder. We cystoscopically combined subureteric injection of dextranomer/hyaluronic acid copolymer and electrocautery to induce ureteral stump occlusion. Results: Postoperative cystogram at 2 weeks showed resolution of extravasation from the ureteral stump. The patient remains symptom-free with complete resolution of the stump reflux at 2 months after discontinuation of the bladder drainage. Conclusions: In the uncommon event of a refluxing ureteral stump after nephrectomy, endoscopic combination of dextranomer/hyaluronic acid copolymer injection and electrocautery to the ureter is a minimally invasive option to successfully occlude the ureter and prevent extravasation.