Ureteric rupture is rare but has been described. It may be spontaneous or secondary to another pathology or intervention.
The most common symptoms are sudden, severe, persistent lower abdominal pain with severe peritoneal irritation. Abdominal compartment syndrome, respiratory distress, and anuria have also been reported.
Most common causes of ureteric injuries are traumatic, with non-traumatic cases being much less frequent. Some of the common causes are:
- blunt, or less commonly, penetrating trauma
- neoplastic processes of the ureter or surrounding invading tumours
- obstruction and dilatation, e.g. ureteric calculi, obstructing tumour
- instrumentation, e.g. cystoscopy, ureteric stent insertion
It has been described as a sensitive method in diagnosing ureteric rupture; nevertheless, the expected poor resolution of this study in unprepared patients make it less favourable compared to CT.
CT is considered the optimal evaluation for diagnosing ureteric rupture. The accurate size and location of the urinoma, as well as its progression can be assessed with delayed (excretory) phase images.
Treatment and prognosis
Many authors have resorted to open surgery earlier for complete management of spontaneous rupture and urinoma. However, Stravodimos et al reported successful treatment of ureteric rupture by the insertion of a double-J ureteric stent under fluoroscopy.
Complications of ureteric stricture, ureteropelvic stenosis, or peri-ureteric fibrosis are expected, yet their true incidence remain unknown.
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- 5. Choi SK, Lee S, Kim S et-al. A rare case of upper ureter rupture: ureteral perforation caused by urinary retention. Korean J Urol. 01;53 (2): 131-3. doi:10.4111/kju.2012.53.2.131 - Free text at pubmed - Pubmed citation
- 6. Stravodimos K, Adamakis I, Koutalellis G et-al. Spontaneous perforation of the ureter: clinical presentation and endourologic management. J. Endourol. 2008;22 (3): 479-84. doi:10.1089/end.2007.0196 - Pubmed citation