title: Spontaneous ureteral rupture: is immediate surgical intervention always necessary? Presentation of four cases and review of the literature.
abstract: OBJECTIVE
  We report our experience with spontaneous ureteral rupture (SUR) managed conservatively.
  
  
  METHODS
  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.
authors.affiliation: Department of Urology, Kadir Has University, Istanbul, Turkey. halukakpinar@lycos.com
authors.forename: Haluk
authors.initials: H
authors.lastname: Akpinar
authors.forename: Ali Riza
authors.initials: AR
authors.lastname: Kural
authors.forename: Ilter
authors.initials: I
authors.lastname: Tüfek
authors.forename: Can
authors.initials: C
authors.lastname: Obek
authors.forename: Oktay
authors.initials: O
authors.lastname: Demirkesen
authors.forename: Vural
authors.initials: V
authors.lastname: Solok
authors.forename: Adil
authors.initials: A
authors.lastname: Gürtug
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011859:Radiography; D012422:Rupture, Spontaneous / Q000000981:diagnostic imaging / Q000601:surgery / Q000628:therapy; D019564:Unnecessary Procedures; D014515:Ureteral Diseases / Q000000981:diagnostic imaging / Q000601:surgery* / Q000628:therapy*; D018666:Ureteroscopy