title: Spontaneous forniceal rupture: Can it be treated conservatively?
abstract: BACKGROUND
  Spontaneous forniceal rupture is one of the possible complications of urolithiasis. The mechanism of forniceal rupture is not well explained in the literature. Most of the cases presented with sudden onset of acute renal colic and diagnosed by noncontrast CT (NCCT). Until now there is no solid consensus about the ideal management of such a condition.
  
  
  OBJECTIVE
  To study indications and validity of conservative management of spontaneous caliceal rupture.
  
  
  METHODS
  This is an observational prospective study.
  
  
  METHODS
  All cases diagnosed as spontaneous forniceal rupture in our departments from 2011 to 2015 were enrolled. All cases were diagnosed with NCCT or CT-Urography.. Non complicated patients were primarily managed conservatively. Intervention (DJ stent insertion, nephrostomy tube insertion, or urgent ureteroscopy) was reserved to complicated cases or solitary kidney. Drainage of urinoma was done in cases with sizable urinoma (more than 100 ml3).
  
  
  RESULTS
  A total of 40 patients: Twenty eight (70%) patients had normal serum creatinine level at presentation, while 12 (30%) patients had elevated serum creatinine. Twenty three (57.5%) patients were successfully managed conservatively, their mean size of stone was 6.2 ± 2 mm and the hospital stay was 3.1 ± 1.9 days. Eighteen patients (42.5%) underwent interventions. Their stone size was 4.5 ± 2.1 mm and the hospital stay for the interventional group was 4.2 ± 1.8 days.
  
  
  METHODS
  Mann-Whitney test was used for testing difference between means because the data groups are not parametric. Otherwise, simple descriptive statestics were used.
  
  
  CONCLUSIONS
  Spontaneous forniceal rupture is more likely to occur with smaller distal ureteric stones. Conservative management is a valid option in non-complicated cases. Intervention should be reserved to complicated cases or cases with sizable urinoma.
authors.affiliation: Departrment of Urology, Mubarak Alkabeer Hospital, Kuwait, Saudi Arabia.
authors.forename: Ahmed Gaber
authors.initials: AG
authors.lastname: Al-Mujalhem
authors.affiliation: Department of Urology, Faculty of Medicine, Menoufia University, Egypt.
authors.forename: Mohammed Sayed Ahmed
authors.initials: MS
authors.lastname: Aziz
authors.affiliation: Department of Urology, Faculty of Medicine, Menoufia University, Egypt.
authors.forename: Mohammed Farag
authors.initials: MF
authors.lastname: Sultan
authors.affiliation: Department of Radiodiagnosis, Faculty of Medicine, Zagazig University, Egypt.
authors.forename: Ahmed Mohammed
authors.initials: AM
authors.lastname: Al-Maghraby
authors.affiliation: Department of Urology, Faculty of Medicine, Menoufia University, Egypt.
authors.forename: Mohammed Abdelmonem
authors.initials: MA
authors.lastname: Al-Shazly
keywords: Forniceal; rupture; stone