Background: Urinary fistula is a common complication of kidney transplantation. It may cause severe complications like graft loss and patient death.
Case presentation: Here we present a recipient who developed graft ureteral necrosis with leakage of urine into the superficial perineal space but not into the peri-graft or the retroperitoneal space, as an unusual clinical feature. This may be due to dense adhesions in the peri-graft region and dam-like effect of adhesive spermatic cord and inferior epigastric vessels traversing across the graft ureter. Urine leaking out with high pressure extravasates through the potential gaps in the incision of aponeurosis at the lateral margin of the rectus abdominis and into the superficial perineal space. The proximal ureter of the graft was end-to-end anastomosed to the right ureter. Both the recipient and graft recovered well.
Conclusions: Comparing the creatinine levels in the leaking fluid and serum is an effective way to confirm urinary fistula. Early aggressive management is a rational option for treatment of urinary fistula.