Intraperitoneal Urinary Leak Presenting as Severe AKI After Robotic-Assisted Laparoscopic Radical Prostatectomy (RALRP)
- AKI: Mechanisms - Case Reports
November 03, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Acute Kidney Injury
- 103 AKI: Mechanisms
- Alzyood, Laith, Albert Einstein College of Medicine, Bronx, New York, United States
- Ali, Mahmoud, St Barnabas Hospital, Bronx, New York, United States
- Kumar, Neelja D., Albert Einstein College of Medicine, Bronx, New York, United States
About one in five hospitalizations is complicated by AKI, and patients with urological diseases are at higher risk of developing AKI, but severe AKI is a rare event after prostate surgery. We present a unique case of AKI following RALRP.
A 60-year-old male with hypertension, type 2 diabetes, prostate cancer and normal kidney function at baseline, presented with severe lower abdominal pain six days after RALRP. His surgical drains were removed a day prior to presentation, but his urinary catheter was maintained. Abdominal exam revealed a tender right lower abdomen and clean surgical sites. He was afebrile, blood pressure was 149/86 mmHg, and pulse was 94 beats/minute. A non-contrast abdominopelvic computed tomography (CT) showed a pelvic hematoma to the right of the urinary bladder with small locules of gas. There was also a lower density fluid collection in the surgical bed. His serum creatinine was 1.72 mg/dL, potassium was 4.2 mEq/L, and blood urea nitrogen was 22 mg/dL. Hemoglobin was 10 g/dL. WBC, platelet count, creatinine kinase and coagulation profile were all within normal limits. Urinalysis was positive for blood, but negative for infection. The patient had worsening abdominal distension and pain and an abdominal ultrasound showed a new development of moderate ascites. At that time, patient also had doubling of his serum creatinine to 4.21 mg/dL while maintaining adequate urine output. Abdominal paracentesis performed in the left lower quadrant aspirated 2 liters of bloody fluid. Analysis of the peritoneal fluid showed creatinine of 10.4 mg/dL. A CT cystography confirmed a vesicourethral urinary leak with expansion into the peritoneal cavity. A pelvic drain was placed, resulting in normalization of serum creatinine and resolution of abdominal ascites.
RALRP has become the dominant surgical approach for radical prostatectomy in the United States. Vesicourethral urinary leak is a common complication following RALRP, but the reported incidence of expansion of those leaks into the peritoneum was 1% and <0.5% required CT-guided drainage. Our case is unique given the acute presentation of severe non-oliguric AKI after RALRP with development of ascites after removal of the surgical drain resulting in pseudo-AKI from increased creatinine absorption through the peritoneal membranes.