A rare twist after Ex-vivo RIRS: graft parenchymal urine leak in a living donor kidney.
Asad Bashir, Nasrum Minallah, Fiaz Ahmed Touqeer et al.
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Case in brief
A 29-year-old man received a living-donor kidney after ex-vivo retrograde intrarenal surgery (RIRS) to remove a 5 mm upper-pole calculus. Postoperatively, bloody drain output led to re-exploration, which identified a capsular tear. When the drainage became clear, elevated drain-fluid creatinine and CT urography confirmed a graft parenchymal urine leak. The bleeding was managed surgically; the leak was treated conservatively with prolonged drainage and a double-J stent. Graft function remained stable.
What made this case unusual
The report describes graft parenchymal urine leakage after ex-vivo RIRS in a living-donor kidney transplant, an exceptionally rare complication according to the authors.
Diagnostic / clinical pearl
Clear postoperative drain output after bleeding from a capsular tear may represent a parenchymal urine leak; drain-fluid creatinine and CT urography helped confirm the diagnosis in this case.
Why it matters
The authors emphasize controlling irrigation pressure during ex-vivo RIRS and promptly identifying complications to help preserve graft function.