Renal Forniceal Rupture in the Setting of Obstructing Ureteral Stones: An Analysis of Stone Characterization and Urologic Intervention Pattern

Setia, Shaan; Massie, Pierce; Epsten, Madeline; Sharma, Ashish; Fogg, Louis; Cherullo, Edward E.; Chow, Alexander K.

doi:10.1089/end.2019.0706

Cited by 11 publications

(17 citation statements)

References 16 publications

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“…Obstruction in the distal ureter, including the vesicoureteric junction (VUJ) is responsible 54.9–87.5% of presentations. 4–8 ,13,14,18 The causes of RFR in adults are summarised in Table 1 and urolithiasis related RFR by stone location is presented in Table 2.…”

Section: Resultsmentioning

confidence: 99%

“…Patients with RFR secondary to urolithiasis are commonly cited as having a high risk of developing renal and perinephric abscesses, prompting clinicians to treat all patients (92–100%) with prophylactic antibiotics, while positive urine cultures are reported in the range 15–34.9%. 4,6–8,13,14,18 There are certainly historical cases of RFR due to ureteric obstruction causing perirenal abscesses and groups have reported 10.5–16.9% of these abscesses are attributable to ureteric obstruction (with causes including ureterolithiasis). 19–21 However, the converse association is less significant – only one perirenal abscess was reported in 476 patients across the seven case series of RFR published in the last two decades, occurring after intervention and discussed below.…”

Section: Resultsmentioning

confidence: 99%

“…4,6–8,13,14,18 There are certainly historical cases of RFR due to ureteric obstruction causing perirenal abscesses and groups have reported 10.5–16.9% of these abscesses are attributable to ureteric obstruction (with causes including ureterolithiasis). 19–21 However, the converse association is less significant – only one perirenal abscess was reported in 476 patients across the seven case series of RFR published in the last two decades, occurring after intervention and discussed below. 4,6–8,13,14,18 This low incidence of abscess formation could be attributable to concomitant antibiotic treatment, indiscriminately used prophylactically in most cases.…”

Section: Resultsmentioning

confidence: 99%

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Managing renal forniceal rupture secondary to ureteric calculi in line with the NICE 2019 Renal and Ureteric Stone Guidelines

Harvey

Rudman

Gall

2020

Journal of Clinical Urology

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Objective: To synthesise all available data to determine the best management for urolithiasis-related renal forniceal rupture (RFR), with particular reference to the National Institute for Health and Care Excellence (NICE) 2019 Renal and Ureteric Stone Guidelines. Methods: PubMed search to March 2020 using permutations of renal, forniceal, fornix, calyceal, calyx and rupture. Non-English abstracts, editorial comments, letters to the editor and abstracts of conference proceedings were excluded. Results: An initial PubMed search retrieved 126 titles which were screened for relevance and five further titles were added from associated references. 64 abstracts were subsequently assessed, with 25 articles proceeding to full paper review. Conclusions: In cases of RFR secondary to ureteric calculi, management options, including conservative management, for the stone should be considered without the decision being influenced by the presence of the rupture. Perirenal abscesses secondary to RFR are rare, occurring in less than 0.25% of cases. Evidence supports restricting antibiotic prophylaxis to patients with a history of recurrent urinary tract infections or a positive urine culture, in line with the European Association of Urology’s antibiotic stewardship general management principle. RFR is not inherently a contraindication to primary ureteroscopy, which has particularly relevance with the drive to meet the 2019 NICE recommendations. Level of evidence: Not applicable to this literature review.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Managing renal forniceal rupture secondary to ureteric calculi in line with the NICE 2019 Renal and Ureteric Stone Guidelines

Harvey

Rudman

Gall

2020

Journal of Clinical Urology

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“…3 Stone size or location does not impact whether forniceal rupture will occur or not. 4 A retrospective review found that stones causing forniceal rupture were in the proximal ureter in 24.3% of cases, distal ureter in 17.6% of cases and at the vesicoureteric junction in 58.1% of cases. 5 In patients with forniceal rupture, there is a high risk of abscess formation and urosepsis, both of which carry a high mortality rate.…”

Section: Discussionmentioning

confidence: 99%

Case Report: Not Your Typical Kidney Stone

Kolster¹,

Biggs²

2021

Journal of Education and Teaching in Emergency Medicine

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“…superimposed infection, kidney injury), risk factors for complications (e.g. sizeable urinoma 100 mL or larger) or a solitary kidney [ 10 – 12 ]. The detection of further contrast extravasation or unresolving urinoma in this case would have prompted consideration of drainage and urinary diversion.…”

Section: Discussionmentioning

confidence: 99%

Spontaneous bilateral renal pelvis rupture during CT in the absence of urinary tract obstruction: case report

Beh

2020

BMC Urol

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Background: Atraumatic renal pelvis rupture without pre-existing renal or ureteric pathology is an uncommon event. It is reported in the setting of acute urinary tract obstruction, most often secondary to ureteric calculi. Typical symptoms include acute flank pain and nausea, mimicking pyelonephritis or other causes of acute abdomen. Spontaneous rupture occurring bilaterally without identifiable urinary tract obstruction is exceedingly rare, and has yet to be reported in current English literature. Possible contributing pathophysiological mechanisms can be postulated from reported cases of rupture with observed obstruction. Case presentation: A 58-year-old woman undergoing multiphasic computed tomography (CT) for evaluation of asymptomatic microscopic haematuria developed on-table bilateral renal pelvis rupture seen only after contrast administration, on the delayed phase. There was no significant past medical history of note. The patient remained asymptomatic throughout and after the study, and was managed conservatively. Follow-up radiographical imaging over a month showed resolution of urinoma and no further contrast extravasation. No complications or recurrence was subsequently noted. Conclusions: Spontaneous rupture of the renal pelvis can be a rare complication of intravenous contrast administration even in cases without identifiable urinary tract obstruction, and it can occur bilaterally. Cases can uncommonly be asymptomatic but typical symptoms should prompt evaluation of the kidneys, particularly when they are not included in the initial study or no delayed phase is protocolled. Interval imaging for resolution of urinoma and contrast extravasation is clinically relevant to monitor for and avoid infective sequelae.

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Renal Forniceal Rupture in the Setting of Obstructing Ureteral Stones: An Analysis of Stone Characterization and Urologic Intervention Pattern

Cited by 11 publications

References 16 publications

Managing renal forniceal rupture secondary to ureteric calculi in line with the NICE 2019 Renal and Ureteric Stone Guidelines

Managing renal forniceal rupture secondary to ureteric calculi in line with the NICE 2019 Renal and Ureteric Stone Guidelines

Case Report: Not Your Typical Kidney Stone

Spontaneous bilateral renal pelvis rupture during CT in the absence of urinary tract obstruction: case report

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