Spontaneous ureteral rupture and review of the literature.
BACKGROUND
Spontaneous ureteral rupture is defined as non-traumatic urinary leakage from the ureter. This is a diagnosis that, although uncommon, is important for emergency physicians to know about. The literature is relatively sparse.


METHODS
This was a retrospective review of patients who were diagnosed with spontaneous ureteral rupture. From 2006 to 2012, 18 patients were diagnosed by radiography (computed tomography or intravenous urogram) with spontaneous ureteral rupture. These cases all showed extravasation of the contrast outside the excretory system. We evaluated underlying causes, diagnostic and therapeutic procedures, and outcomes.


RESULTS
There were 9 men and 9 women with a median age of 59 years (range, 22-82 years). In 56% of patients, a ureteral stone was the cause; in 17% of, a ureteral stricture; in 1 patient, a ureteral tumor; and in the remaining 22%, no cause was identified. In 13 patients (72.2%), primary ureteroscopy to place D-J stents was performed. The average duration of ureteral catheter stenting was 21 days (range, 8-45 days). The other 5 patients (27.8%) were managed conservatively with antibiotic treatment and the outcome was good.


CONCLUSIONS
Ureteral stones most commonly cause spontaneous ureteral rupture. In our experience, most patients received ureteroscopy and Double-J stenting. Conservative management with antibiotics also had good outcomes. Most patients had sudden onset of abdominal or flank pain. Spontaneous ureteral rupture should be kept in the differential diagnosis of patients with acute abdominal or flank pain in the emergency department.
Department of Urology, China Medical University Hospital, Taichung, Taiwan.
Guang-Heng
GH
Chen
Department of Urology, China Medical University Hospital, Taichung, Taiwan.
Po-Jen
PJ
Hsiao
Department of Urology, China Medical University Hospital, Taichung, Taiwan.
Yi-Huei
YH
Chang
Department of Urology, China Medical University Hospital, Taichung, Taiwan.
Chi-Cheng
CC
Chen
Department of Urology, China Medical University Hospital, Taichung, Taiwan; School of Medicine, China Medical University, Taichung, Taiwan.
Hsi-Chin
HC
Wu
Department of Urology, China Medical University Hospital, Taichung, Taiwan.
Chi-Rei
CR
Yang
Department of Urology, China Medical University Hospital, Taichung, Taiwan.
Kuo-Liang
KL
Chen
Department of Urology, China Medical University Hospital, Taichung, Taiwan; School of Medicine, China Medical University, Taichung, Taiwan.
Eric Chieh-Lung
EC
Chou
Department of Urology, China Medical University Hospital, Taichung, Taiwan.
Wen-Chi
WC
Chen
Department of Urology, China Medical University Hospital, Taichung, Taiwan; School of Medicine, China Medical University, Taichung, Taiwan. Electronic address: D20932@mail.cmuh.org.tw.
Chao-Hsiang
CH
Chang
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D003251:Constriction, Pathologic / Q000150:complications; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012422:Rupture, Spontaneous / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy; D015607:Stents; D014057:Tomography, X-Ray Computed; D014514:Ureteral Calculi / Q000150:complications; D014515:Ureteral Diseases / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D014516:Ureteral Neoplasms / Q000150:complications; D018666:Ureteroscopy; D014567:Urography; D055815:Young Adult
D000900:Anti-Bacterial Agents