The diagnosis and management of spontaneous rupture of the ureter

The first case of spontaneous upper ureteric rupture caused by emphysematous pyelitis

Spontaneous ureteric rupture is a very rare condition which usually occurs due to ureteric obstruction caused by obstructing calculi; in our case, the cause was emphysematous pyelitis, which was considered the first report in the literature as far as we know.

Peritoneal perforation and peritonitis after antegrade double-J stent insertion: A case report and review of the literature

Penetration of peritoneal cavity during antegrade double-J (DJ) stenting is rare. A 52-year-old woman presented with signs of peritonitis for 3 days after left PCNL. Abdominal CT scan revealed a perforation of the peritoneum by the distal coil of DJ stent, which was reinserted into the bladder by ureteroscopy.

Spontaneous proximal ureteric rupture secondary to ureterolithiasis

We present the case of a 37-year-old lady who presented with severe colicky left sided flank pain associated with vomiting, chills and rigors. A non-contrast Computed Tomography of the Kidney Ureter and Bladder was performed which showed a 2-3 mm stone in the pelvic part of the left ureter. Following 2 days of conservative treatment she was still complaining of increasingly severe pain. A contrast computed tomography of the abdomen was performed which was suggestive of a perforation of the left collecting system. A diagnosis of spontaneous left proximal ureteric perforation secondary to urolithiasis was made. We opted to treat her with retrograde endoscopic ureteric stent insertion. Spontaneous rupture of the ureter is a relatively rare urological occurrence with only a small number of cases reported in the literature. Although there are no recommendations, ureteric double-J stenting is the most commonly used management option with good results reported.

A rare case of upper ureter rupture: ureteral perforation caused by urinary retention

Perforation of the ureter is a rare condition that causes a series of problems including retroperitoneal urinoma, urosepsis, abscess formation, infection, and subsequent renal impairment. There are causative factors that induce ureteric rupture, including malignancy, urinary calculi, idiopathic retroperitoneal fibrosis, recent iatrogenic manipulation, external trauma, degenerative kidney conditions, urography with external compression, and spontaneous causes. We report a rare case of ureteric rupture caused by urinary retention. The patient was treated with temporary percutaneous drainage and antibiotics. The present case illustrates that urinary retention can induce not only bladder rupture, but also ureteric rupture. It is thus of paramount importance to effectively manage patients with voiding problems.

Rupture of the ureter mimicking acute renal infarction: case report and review of the literature

We describe a case of acute rupture of the left proximal ureter as a result of lithiasis. The patient presented with a clinical picture of renal infarction: unilateral flank pain, more than 500 red blood cells per microliter urine and increased serum LDH levels. Abdominal ultrasound as well as a CT scan showed no abnormalities. Only CT angiography of the kidneys was able to demonstrate an acute rupture of the left proximal ureter with extravasation of contrast. Intravenous pyelogram confirmed this rupture with leaking of the contrast. One day after admission the patient urinated a 2 mm large calciumoxalate-monohydrate stone, the likely cause of the rupture. The rupture healed spontaneously. A review of the literature is given.

Spontaneous perforation of the ureter: clinical presentation and endourologic management

BACKGROUND AND PURPOSE

Spontaneous perforation of the upper ureter is a rare condition that poses diagnostic and therapeutic problems. We report on five cases from three institutions and discuss the literature.

PATIENTS AND METHODS

Five patients presented with renal colic and the imaging modalities used to assess them showed extravasation of urine.

RESULTS

The cause of spontaneous perforation of the ureter was a ureteral stone in one case and was unknown in four cases. In all cases, a Double-J ureteral stent was inserted under fluoroscopy. Urinoma was percutaneously drained in only one patient. Repeat imaging showed normal renal function and morphology in all patients.

CONCLUSION

Spontaneous perforation of the ureter should be suspected after renal colic. Endourologic treatment offers excellent results, even for the management of acute complications.

Intraperitoneal rupture of the ureter as a cause of generalized peritonitis: report of a case

We report a rare case of generalized peritonitis caused by nontraumatic, intraperitoneal rupture of the ureter. An 80-year-old woman with a history of bilateral vesicoureteral reflux and long-term urethral indwelling catheter drainage presented with a very distended abdomen. Computed tomography showed massive ascites and intraperitoneal free gas. We performed an emergency laparotomy, assuming a gastrointestinal perforation; but could not find a cause of generalized peritonitis. Postoperatively, she presented with anuria and massive peritoneal drainage. The findings of a cystogram confirmed intraperitoneal ureteral rupture. She was managed successfully with ureteral stenting. The diagnosis of this condition requires a high degree of clinical suspicion, along with radiographic evidence and peritoneal fluid analysis. Image-guided interventions play a crucial role in the management of ureteral urine leaks after a correct diagnosis has been made.

Spontaneous ureteral rupture: is immediate surgical intervention always necessary? Presentation of four cases and review of the literature

PURPOSE

We report our experience with spontaneous ureteral rupture (SUR) managed conservatively.

CASE REPORTS

Data on three men and one woman 53 to 89 years old (mean age 73) with SUR were retrospectively evaluated. The common complaint was sudden-onset abdominal and concomitant flank pain. On physical examination, all patients had abdominal tenderness and pain with costovertebral angle tenderness on the associated side. One patient had rheumatoid arthritis treated with corticosteroids, and one had carcinoma of the prostate. All patients had urinary extravasation on CT scans. Two patients had ureteral obstruction by stones, and another had bladder outlet obstruction secondary to prostate cancer. Interestingly, irrespective of the obstruction level, the rupture was near the ureteropelvic junction in all patients. The symptoms regressed within hours after basket catheterization and ureteral stent placement in one patient and close follow-up and supportive treatment in three patients. In two patients, disappearance of extravasation and reabsorption of perirenal fluid were confirmed by second- and third-day CT scans. The patients were followed for a mean of 17 (range 14-21) months without any problems.

CONCLUSIONS

We believe that SUR cases are more frequent than reported. It is the authors' opinion that if the clinical scenario is suspected in the acute phase and investigated by appropriate radiologic techniques, many more SUR cases will be diagnosed. Careful monitoring with supportive measures may be curative in the majority of the patients, obviating a surgical intervention.

Rottura spontanea dell'uretere: Due casi: Spontaneous rupture of the ureter: Two cases

Spontaneous rupture of the ureter is rare, usually ending in a periureteral abscess. Two cases of spontaneous rupture of the ureter secondary to calculosis in patients with ureterosigmoidostomy are described. Surgical management includes immediate drainage of the urinoma with urinary reconstruction (if necessary and possible) or radical surgery.

Spontaneous perforation of the ureter diagnosed on technetium 99m DTPA excretory urography

A case of nontraumatic rupture of the ureter secondary to a nonopaque calculus is presented. Because of the inherent high image contrast caused by the leak of technetium 99m-DTPA-labeled urine, the technetium 99m-DTPA excretory urogram is seen as an alternative to the intravenous urogram or contrast-enhanced computed tomography in selected cases of suspected ureteral rupture.

Spontaneous rupture of ureter

A patient with spontaneous ureteral rupture in the absence of obstruction or calculus disease is presented. In addition to ureteral rupture this patient also had a penile squamous cell carcinoma and infected inguinal lymph nodes. A review of the literature discloses that all reported cases with spontaneous rupture of the ureter had an underlying process leading to that rupture. It is considered, therefore, that rupture of the ureter should be designated as "traumatic" or "nontraumatic." The term "spontaneous," implying a primary event, is a misnomer. No such case has been reported occurring in an otherwise healthy individual.