Primary ureteroscopic treatment for obstructive ureteral stone‐causing fornix rupture

Abstract

Background : Management of fornix rupture (FR) by obstructive stone is comprised of extravasation control and the elimination of the obstruction. For all patients, management initially remains conservative under close follow up. Endoscopic management of FR involved with an obstructive stone of the ureter or the pelviureteric junction (UPJ) consists mainly of stenting the ureter. Our endoscopic approach to this pathological entity comprises of the sole stenting of the ureter, as well as primary ureteroscopic lithotripsy followed by ureter stenting. Patients and methods : In the Department of Urology at the General Hospital of Rhodos Island, Rhodos, Greece, over the last 15 years, 51 of 86 patients with FR due to an obstructive stone, were treated endoscopically. Twenty-two patients underwent sole stenting of the ureter (option A) and 29 patients underwent primary ureteroscopic lithotripsy and stenting (option B). Results : The overall primary 'successful outcome' was achieved in nine of the 22 patients (40.9%) in the group treated with sole stenting, while the remaining 59.1% required secondary interventions. However, 27 of the 29 patients (93.1%) treated with primary ureteroscopic lithotripsy and stenting required no auxiliary treatment.The primary successful outcome results for obstructive middle and lower ureteral stones with FR were eight out of 12 (66.6%) and 26 out of 27 (96.3%) for therapeutic options A and B, respectively. Upper obstructive ureteral stones with FR required secondary intervention in most cases, regardless of the therapeutic option chosen. (In nine out of 10 and one out of two cases for options A and B, respectively).The mean duration of hospitalization for options A and B were 7.6 and 5.3 days, respectively. The mean duration that the ureter stent remained in situ for A and B treatment options was 30.9 and 10.2 days, respectively. Conclusions : Sole stenting of the ureter is reserved for infected FR or for stones of the upper ureter or the UPJ. Ureteroscopic lithotripsy followed by double-J stenting of the ureter may offer a quick and safe therapeutic alternative for distal and middle obstructive ureteral stones with FR.

Spontaneous Rupture of the Renal Pelvis Caused by Calculus: A Case Report

“…Serial ultrasonography may show the obstruction site and fluid extravasation, or hydronephrosis. Resistance index and pulsality index values in the interlobular arteries, evaluated by color duplex Doppler sonography, significantly increase in acute hydronephrosis, and decrease after the elimination of the obstruction (10,12). Intravenous pyelograms and computed tomography with delayed images (obtained 5-20 min after contrast medium injection) show contrast medium extravasation in the peripelvic, perinephric, or retroperitoneal spaces (4,10).…”

Spontaneous Fornix Rupture Due to Obstructive Ureteral Stone

“…If the diagnostic process had been finalized at this stage, fornix rupture would have been overlooked in our case. USG is an easy, cheap, rapid and advantageous radiologic method in patients who cannot be exposed to radiation like pregnants; however, its being dependent on practitioner decreases its reliability (8,9). In the present case, overlooked urinoma on USG was attributed to the above-mentioned disadvantage of the method.…”

“…Plain X-ray and USG are the first choice of radiologic methods in addition to detailed anamnesis and physical examination in the diagnosis of renal fornix ruptures due to obstruction (8). These two methods have the advantages of accessibility due to their common use in emergency services.…”

The Spontaneous Rupture of the Renal Fornix Caused by Obstructive Nephropathy

“…Serial ultrasound evaluations have a high sensitivity for detecting a small amount of fluid extravasation, but a low specificity for distinguishing urinoma from hematoma or abscess. Contrast-enhanced CT with nonenhanced images is the most sensitive and specific noninvasive imaging modality (1). As the urine extravasation may induce sepsis from a urinary tract infection, emergency physicians must consider the possibility of forniceal rupture by obstructive nephropathy in patients with flank pain.…”