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.

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.

Urinary Tract Trauma in Cats: Stabilisation, Diagnosis and Management.

PRACTICAL RELEVANCE: Traumatic injury of the urinary tract may be caused by external accidental trauma or due to iatrogenic injury (typically as a result of catheterisation procedures). Thorough patient assessment and careful attention to patient stabilisation are essential, with diagnosis and surgical repair delayed until the patient is stable, if necessary. Treatment depends on the location and severity of the trauma. If diagnosed and treated promptly, the chance of survival of a patient without other concurrent injuries is good. CLINICAL CHALLENGES: Following accidental trauma, at the initial presentation urinary tract injury can be overshadowed by other injuries, but if left undiagnosed or untreated it can lead to serious morbidity and potentially mortality. Many of the surgical techniques described for management of urinary tract trauma can be associated with complications, and so comprehensive communication with the owners is necessary. PATIENT GROUP: The main population affected by urinary tract trauma is young, adult male cats, owing to their roaming behaviour, as well as their anatomy and the resulting increased risk of urethral obstruction and its associated management. AIMS: This article aims to serve as a guide to all veterinarians who treat cats for the diagnosis and management of urinary tract trauma in cats. EVIDENCE BASE: This review summarises the current knowledge available from a number of original articles and textbook chapters in the literature that cover all aspects of feline urinary tract trauma, and is supported by the authors' own clinical experience.

Case of bilateral hydronephrosis and spontaneous ureteral rupture as a rare complication of prostate biopsy.

Development of bilateral hydronephrosis and ureteric rupture has never been reported in the published literature so far. We describe a case of 51years old gentleman who developed this complication aftertrans-rectal ultrasound guided prostate biopsy. The patient was treated with bilateral double-J stent insertion, intravenous antibiotic therapy and recovered completely. There have been reports of hydronephrosis with or without ureteric rupture in the world literature. The causes reported have been such as malignancy, stones, retroperitoneal fibrosis, iatrogenic manipulation, trauma, degenerative kidney conditions and spontaneous causes. This could lead to development of retroperitoneal urinoma, urosepsis, abscess formation, infection and renal impairment.

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.

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.

Spontaneous ureteric rupture secondary to an invasive desmoid tumour.

INTRODUCTION: Spontaneous ureteric rupture is a rare entity that presents as an extravasation of urine from the ureter without previous surgery, ureteric manipulation and external trauma of the ureter. We report the case of a desmoid tumour presenting as spontaneous ureteric rupture which was managed in our institution. PRESENTATION OF CASE: A 28 years old healthy male presented with a four day history of generalised abdominal pain secondary to spontaneous right ureteric rupture. Patient was initially managed via insertion of nephrostomy tube and antibiotics. After unsuccessful attempts of retrograde and antegrade ureteric stent insertion, patient was subsequently managed via elective surgical intervention. The excised specimen revealed desmoid tumour as cause of the ureteric rupture. DISCUSSION: Desmoid tumours are rare benign tumours arising from fascial or musculoaponeurotic structures that do not metastasise, but tend to invade locally. It is often initially managed medically prior to undertaking a definitive surgical intervention. To our knowledge this is the first reported case of ureteric perforation secondary to a desmoid tumour of the mesentery. CONCLUSION: Spontaneous rupture of the ureter is often misdiagnosed as other conditions. History taking and examination can be unreliable, hence a high level of suspicion and further investigations should be utilised. Once the diagnosis is made, treatment can be individualised based on aetiology.