Ureteric rupture

Last revised by Mostafa El-Feky on 18 Jun 2020

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 tumors
  • obstruction and dilatation, e.g. ureteric calculi, obstructing tumor
  • radiotherapy
  • 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 favorable 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. 

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 remains unknown. 

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Cases and figures

  • Case 1: iatrogenic rupture of the ureter
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  • Case 2
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  • Case 3: iatrognic ureteric rupture
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  • Case 4: secondary to acute ureteric obstruction with stone
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  • Case 5: post-traumatic ureteric rupture
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