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.

Female Gonadal Venous Insufficiency in a Clinical Presentation Which Suggested an Acute Abdomen-A Case Report and Literature Review

Pelvic venous insufficiency (PVI) is frequently associated with symptoms of abdominal pain or discomfort that is overlooked or under-diagnosed in women. Despite the fact that pelvic venous insufficiency in men is very well documented, its occurrence in women needs to be further studied. Patients with pelvic varicose veins undergo a long and inconclusive diagnostic work-up before the exact cause of the symptoms is identified. Gonadal venous insufficiency (GVI) is a condition that can present acutely, leading to diagnostic challenges. We present a case report of a 47-year-old female with acute abdominal pain and GVI, where endovascular embolization was used for successful treatment. The patient was diagnosed with GVI based on imaging findings of an enlarged left ovarian vein with retrograde flow and dilated pelvic veins seen on magnetic resonance imaging (MRI) with contrast material. Due to the severity of her symptoms and imaging findings, endovascular embolization was chosen as the treatment modality. The embolization was successful, and the patient's symptoms resolved completely. This case highlights the challenge of diagnosing GVI with acute clinical expression and the potential benefits of endovascular embolization as a treatment option. Further studies are needed to determine the optimal management strategies for acute GVI, but endovascular embolization should be considered a safe and effective option. At the same time, we present a short review of the recent literature data related to this topic.

A Case of Spontaneous Ureteral Rupture Mimicking Renal Colic

A 67-year-old female presented to the emergency department with acute-onset severe left flank pain as well as nausea and vomiting. Physical examination was notable for left-sided abdominal, flank tenderness, and costovertebral angle tenderness. Laboratory workup revealed an elevated lactate of 9.2 mmol/L and elevated serum creatinine of 1.14 mg/dL, with an estimated glomerular filtration rate of 53 mL/minute/1.73m². Urinalysis showed moderate leukocyte esterase with microscopy showing 12 white blood cells and three red blood cells per high-power field. CT of the abdomen and pelvis with intravenous contrast was notable for moderate amounts of left-sided perinephric and periureteric fluid without the presence of an obstructing calculus. Due to the amount of perinephric and periureteric fluid without associated nephrolithiasis, the differential diagnosis was broadened to include spontaneous ureter rupture as well as concern for malignancy. A delayed post-contrast CT scan of the abdomen and pelvis was obtained, which confirmed a spontaneous proximal and mid-ureter rupture. Spontaneous ureter rupture is a rare disease process with significant morbidity and mortality. It often poses a diagnostic dilemma due to a lack of clinical awareness and varied presentation. Diagnosis rests upon obtaining delayed post-contrast CT of the abdomen and pelvis. Currently, there are no standardized treatment guidelines, although most experts utilize minimally invasive endourological approaches in their treatment plans.

Tranexamic acid-induced ureteric clot obstruction in a patient with urothelial cell carcinoma resulting in upper urinary tract perforation

This is the first report of upper urinary tract (UUT) perforation secondary to tranexamic acid (TXA) induced ureteric clot obstruction. A 77-year-old woman was referred to the urology department with intermittent, painless visible haematuria from a lesion in the right upper calyx, suspicious of urothelial cell carcinoma. She did not have any flank pain or blood clots in her urine. Preoperatively, her haemoglobin level dropped from 113 g/L to 95 g/L and was prescribed oral TXA by her general practitioner, which led to extensive clot formation within the right kidney and ureter resulting in pain and ureteric obstruction. At ureteroscopy, a large ureteric blood clot was extracted and perforation close to the tumour with resultant urinary extravasation was noted. The patient subsequently underwent a successful nephroureterectomy, but risk of potential perforation-related complications such as tumour seeding, sepsis and urinoma formation could have been avoided. TXA in haematuria from the UUT should be strongly discouraged due to the risk of ureteric clot obstruction and UUT perforation.

Ureteropelvic junction obstruction causing a spontaneous collecting system rupture: A case report and review of the literature

Stones are the most common cause of collecting system ruptures. There are few reported cases of a ruptured collecting system without an underlying pathological cause. We report a case of a 15-year-old female patient who presented with left flank pain that was associated with nausea and vomiting. Computed tomography revealed a large, left retroperitoneal fluid collection, which was associated with severe hydronephrosis without an obvious pathological cause. The patient was treated with the insertion of a left double-J stent, and a retrograde pyelography confirmed the cessation of extravasation. At follow up, she was treated surgically with left robotic-assisted pyeloplasty without complications.

An Interesting Case of Critical Spontaneous Ureteral Rupture

Spontaneous rupture of the ureter in an uncommon presentation. We present a case of an 85-year-old female patient with a past medical history significant for hypertension and hyperlipidemia who presented to the emergency room (ER) due to abdominal pain and nausea. Computed tomography (CT) of abdomen and pelvis revealed proximal ureteral and ureteropelvic junction rupture with fluid within the left retroperitoneum and pelvis. No clear etiology was identified. The patient had a left percutaneous nephroureteral catheter tube (PNCT) placed in addition to being given broad-spectrum antibiotics for possible infection. She was noted to improve and was discharged with outpatient follow-up for tube removal.

Our patient presented with a rupture of the ureter; however, the source remained elusive. CT scan assisted with the diagnosis but there is no evidence of hydronephrosis or mass. There are no clear treatment guidelines for spontaneous ureteral rupture as the presentation is rare. Treatment may involve percutaneous drainage and possibly antibiotics for concurrent infection. Surgical intervention may be required in cases where severe complications arise. Early diagnosis and management may prevent long-term morbidity and mortality.

Spontaneous Ureteric Rupture and Its Implications in the Emergency Department: A Case Report

INTRODUCTION

Spontaneous ureteric rupture is uncommon and has a wide range of presentations. Accurate diagnosis and timely treatment is necessary to avoid potential serious complications.

CASE REPORT

We present the case of a 55-year-old female who presented with severe right lower abdominal pain with rebound tenderness, vomiting, and a single episode of hematuria. A computed tomography with intravenous contrast of the abdomen and pelvis showed a 0.3-centimeter right upper ureteric calculus, with hydronephrosis and ureteric rupture. In view of the scan findings, a diagnosis of spontaneous ureteric rupture secondary to urolithiasis was made. The patient underwent a percutaneous nephrostomy and ureteric stenting.

CONCLUSION

Spontaneous rupture of the ureter is an uncommon diagnosis for which clinical and laboratory signs may not always be reliably present. A high index of suspicion is required for diagnosis, which is usually confirmed on advanced imaging. It may occur in serious complications of urinoma and abscess formation. As such, accurate diagnosis and timely treatment is crucial.

Spontaneous bilateral renal pelvis rupture during CT in the absence of urinary tract obstruction: case report

BACKGROUND

Atraumatic renal pelvis rupture without pre-existing renal or ureteric pathology is an uncommon event. It is reported in the setting of acute urinary tract obstruction, most often secondary to ureteric calculi. Typical symptoms include acute flank pain and nausea, mimicking pyelonephritis or other causes of acute abdomen. Spontaneous rupture occurring bilaterally without identifiable urinary tract obstruction is exceedingly rare, and has yet to be reported in current English literature. Possible contributing pathophysiological mechanisms can be postulated from reported cases of rupture with observed obstruction.

CASE PRESENTATION

A 58-year-old woman undergoing multiphasic computed tomography (CT) for evaluation of asymptomatic microscopic haematuria developed on-table bilateral renal pelvis rupture seen only after contrast administration, on the delayed phase. There was no significant past medical history of note. The patient remained asymptomatic throughout and after the study, and was managed conservatively. Follow-up radiographical imaging over a month showed resolution of urinoma and no further contrast extravasation. No complications or recurrence was subsequently noted.

CONCLUSIONS

Spontaneous rupture of the renal pelvis can be a rare complication of intravenous contrast administration even in cases without identifiable urinary tract obstruction, and it can occur bilaterally. Cases can uncommonly be asymptomatic but typical symptoms should prompt evaluation of the kidneys, particularly when they are not included in the initial study or no delayed phase is protocolled. Interval imaging for resolution of urinoma and contrast extravasation is clinically relevant to monitor for and avoid infective sequelae.

Spontaneous distal ureteric rupture: A rare case report and review of literature

Spontaneous rupture of the ureter is a very interesting and unusual phenomenon which normally occurs due to ureteral obstruction. We present a case of spontaneous rupture of the distal ureter, secondary to a ureteric calculus. Our patient presented with a history of acute on chronic abdominal pain and was septic on arrival to hospital.

A computational model of ureteral peristalsis and an investigation into ureteral reflux

The aim of this study is to create a computational model of the human ureteral system that accurately replicates the peristaltic movement of the ureter for a variety of physiological and pathological functions. The objectives of this research are met using our in-house fluid-structural dynamics code (CgLes-Y code). A realistic peristaltic motion of the ureter is modelled using a novel piecewise linear force model. The urodynamic responses are investigated under two conditions of a healthy and a depressed contraction force. A ureteral pressure during the contraction shows a very good agreement with corresponding clinical data. The results also show a dependency of the wall shear stresses on the contraction velocity and it confirms the presence of a high shear stress at the proximal part of the ureter. Additionally, it is shown that an inefficient lumen contraction can increase the possibility of a continuous reflux during the propagation of peristalsis.

Spontaneous ureteric rupture, a reality or a faux pas?

BACKGROUND

Rupture of the urinary collecting system with or without any perinephric extravasation is an extremely rare occurrence and usually known to occur following an obstructive pathology. Spontaneous or non-traumatic rupture, in the absence of any distal obstruction, though reported in literature, is not yet a proven entity and needs to be distinguished from physiological forniceal rupture, to validate its occurrence. Our case illustrates that spontaneous ureteric rupture does exist and requires a high level of vigil for prompt diagnosis and early simple management.

CASE PRESENTATION

A 65 year old non diabetic gentleman presented with a 2 day history of right sided severe abdominal pain with no history of any prior trauma, surgery, urinary retention or calculus disease. His ultrasound whole-abdomen was suggestive of increased liver echogenicity, but his contrast enhanced CT scan (CECT) documented a ureteric rupture, with leakage of contrast from the upper ureters, well away from the renal pelvis He was promptly managed with cysto-ureteroscopy, retrograde pyelography (RGP) and double-J (DJ) stenting. His post operative course was uneventful and he was discharged on the second post operative day, without event. An RGP at 6 weeks of follow up showed no contrast extravasation from the ureter and his DJ stent was removed without event.

CONCLUSION

Spontaneous ureteric rupture, in the absence of any inciting cause, is an entity which exists and is easily manageable, once diagnosed timely. Thus, the need to maintain a high index of vigil, in order to identify this clinically entity at the earnest, institute prompt treatment and hence ensure that a "spontaneous" rupture, doesn't become a "faux pas" in the true sense of the word.

Ureteral obstruction by prostate cancer leads to spontaneous ureteric rupture: a case report

Spontaneous ureteric rupture (SUR) is an unusual entity associated with perinephric or retroperitoneal extravasation of urine. Patients with SUR are often presented with severe and progressive abdominal or flank pain. It is commonly related to the obstruction of genitourinary system, among which urinary calculi represents the most frequent cause. Prostate cancer with ureteral orifice invasion can lead to ureteral obstruction, which can also be a threat to SUR. Herein, we present a case of a 68-year-old male with SUR after prostate cancer invaded the left ureteral orifice. To our best knowledge, this is the first case of SUR secondary to ureteral obstruction from prostate cancer.