Integrative approach to nephrocutaneous fistula wound healing: Case report

Abstract

Nephrocutaneous fistula is a very rare, severe non-healing complication following operations involving the kidney. Typical management for such fistula can range from ureteral stent insertion, percutaneous nephrostomy tube placement, or even simple nephrectomy, heminephrectomy, or nephroureterectomy. We present a 78-year-old male who underwent an uncomplicated left partial nephrectomy for a 4.4[Formula: see text]cm renal mass, mostly endophytic, and abutting the collecting system and left renal vein. Two weeks postoperatively, the patient presented with lower back and flank pain along with gross hematuria and was shown to have developed a retroperitoneal hematoma and urinoma at the resection site. The patient underwent a left ureteral stent placement coupled with angioembolization of a pseudoaneurysm identified on cross-sectional computerized tomography (CT) imaging and drain placement. A nephrocutaneous fistula was officially confirmed eight weeks after surgery and the left flank drain was upsized along with additional placement of a left percutaneous nephrostomy tube. Despite the presence of both a flank drain and PCN tube to drain the perinephric fluid collection, there was continuous output from the fistula for six months. An integrative care regimen was introduced and the drain was removed four months later. The patient has not developed a fistula recurrence.