Figure 5a. Ureteral urine leak and urinoma in a 73-year-old man who had undergone abdominoperineal resection for rectal cancer. (a) Contrast-enhanced CT scan demonstrates a fluid collection in the left sigmoid mesentery. (b) CT scan obtained 1 day later during CT-guided needle aspiration demonstrates delayed attenuation of the fluid collection. Results of needle aspiration confirmed that the collection represented a urinoma. Postaspiration evaluation revealed that the cavity had completely resolved, and no percutaneous drainage catheter was placed. The patient underwent left percutaneous nephrostomy to divert urine flow. Attempts at antegrade ureteral stent placement were unsuccessful. (c) Prone antegrade pyelogram obtained following nephrostomy and unsuccessful stent placement demonstrates enhancement and a guide wire within the left ureter. A focal outpouching of extraluminal contrast material (arrow) is seen at the level of complete ureteral transection. (d) Photograph of the 10-F, 20-cm ureteral stent (Boston Scientific, Watertown, Mass) demonstrates that the stent has two pigtails with multiple side holes. This stent may be placed across the level of a ureteral injury, with side holes above and below the level of the urine leak. It is completely internal and is usually removed through the urinary bladder. Ureteral stents come in variable lengths and are typically 8-10 F in diameter. (e) Abdominal radiograph obtained following left retrograde ureteral stent placement demonstrates the stent in satisfactory position.