Figure 6d. Ureteral urinoma in a 40-year-old man with recurrent fevers following pelvic exenteration and ileal loop diversion. (a) Contrast-enhanced delayed phase CT scan demonstrates a presacral urine collection with high attenuation. A percutaneous urinoma drainage catheter (not shown) was placed. (b) Pyelogram obtained after injection of contrast material through the urinoma drainage catheter shows communication of the urinoma with the ileal loop (arrow). Both kidneys were obstructed, and bilateral percutaneous nephrostomy was performed. Management options included ureteral stent placement (if technically possible) and, as a last resort, surgical revision. Stent deployment was attempted. (c) Spot radiograph obtained during stent placement demonstrates a guide wire that has been placed antegrade via the right kidney through the ureteral anastomosis and out the ileal loop. After percutaneous access to the ileal loop via the kidney was established, an exchange-length guide wire (arrows) was inserted to help place a retrograde catheter. A percutaneous nephrostomy catheter (not shown) was left in place. Arrowheads indicate the percutaneous urinoma drainage catheter. (d) Photograph of an 8-F, 30-cm biliary urinary drainage catheter (Boston Scientific) demonstrates that the catheter is long with a single pigtail. The catheter is suitable for ureteral stent placement in patients with ileal loops. In such patients, the distal portion of the stent is external to the patient and is confined within the ileostomy drainage bag. This particular design with a Luer-lock hub facilitates over-the-wire exchanges. These catheters come in lengths of 30 or 45 cm and are typically 8-10 F in diameter. (e) Lateral radiograph shows a right percutaneous nephrostomy catheter (arrow) and a right biliary urinary drainage catheter (arrowheads) placed across a right ureteral-ileal loop anastomotic injury.