Spontaneous renal fornix rupture in pregnancy and the post partum period: a systematic review of outcomes and management

Abstract

Background: Spontaneous renal fornix rupture (SRFR) causing urinoma is an uncommon but serious condition in pregnancy. Limited information is available to describe the natural history and outcomes to guide appropriate treatment. The aim of this study was to determine the natural history and outcomes of SRFR to determine appropriate management recommendations. Methods: A systematic review of literature databases was performed, using the Meta-analysis Of Observational Studies in Epidemiology (MOOSE) checklist from 1950-April 2020. Inclusion criteria included any urinary extravasation from the kidney or ureter during pregnancy, or in the 8 weeks following delivery, confirmed via imaging or surgery. Haematomas and non-confirmed cases were excluded. Results: A total of 1579 records were originally identified, of which 39 case reports were appropriate for inclusion. SRFR was most commonly reported during the first pregnancy (72%), 19/30 during the third trimester and 9 in the postnatal period. All patients presented with pain, with haematuria positive on urine dipstick in only 36% of 26 reported cases. Ultrasound was the most frequently used imaging modality, resulting in a diagnosis in 42% of cases. All cases reported on treatment procedures including ureteric stents (46%), percutaneous drain (15%), conservative management (15%), nephrostomy (13%) and ureteral catherization (10%). Long term urological outcomes were positive, however women suffering SRFR were significantly more likely to undergo pre-term labour. Conclusion: While selected cases may be successfully managed conservatively, urinary diversion, through ureteric stents, should be considered the management of choice in these individuals. Clinicians should be mindful of an increased risk of premature delivery and its' associated negative fetal outcomes.

Spontaneous Renal Rupture During Pregnancy: A Contemporary Literature Review and Guide to Management

“…The most common presenting symptom of renal rupture in pregnancy is acute flank pain. 2,3,6 All patients in a systematic review by McKnoulty et al 3 presented with pain; we also found that 100% of patients in the literature had pain symptoms upon presentation. Additional symptoms include nausea, vomiting, and lower urinary tract symptoms.…”

“…10 A common area of rupture is the fornix of the epithelial transition zone. 3,52 In nondiseased kidneys, rupture occurs in areas where hydronephrosis produces the greatest changes, such as in the pelvis or minor calyces. 10 Although right-sided rupture is more common, there have been case reports of women with spontaneous renal system rupture during pregnancy on the left side without underlying renal conditions as well.…”

“…58 Several imaging modalities for diagnosis of spontaneous renal rupture have been used in the reported cases throughout the literature including ultrasound, computed tomography (CT), and magnetic resonance imaging (MRI). 3,26,33,50 Ultrasound is the first-line imaging modality during pregnancy due to its noninvasive nature and lack of radiation exposure to the mother and fetus. 4,37 Ultrasound has been reported to be helpful in showing hydroureteronephrosis and evidence of perinephric or periureteric fluid collections.…”

“…Preterm delivery is the most common complication.Relevance: Our aim is to increase the awareness of spontaneous renal rupture in pregnancy and its associated complications in order to improve an accurate diagnosis and maternal and fetal outcomes.Target Audience: Obstetricians and gynecologists, family physicians Learning Objectives: After completing this activity, the learner should be better able to identify the risk factors of spontaneous renal rupture in pregnancy; outline the presenting signs and symptoms of renal system rupture during pregnancy; explain the preferred diagnostic tools and imaging modalities for diagnosing renal system rupture in pregnancy, including the risks and benefits to the fetus; and describe the management and potential complications of pregnant patients presenting with renal system rupture.Renal rupture is a rare complication of pregnancy with a limited number of cases reported in the medical literature. [1][2][3] Spontaneous renal rupture is diagnosed when rupture occurs without recent surgery or trauma. 2,4 The concept of spontaneous renal rupture in the general population was introduced by Wunderlich in 1856, and the first case of urinary tract rupture during pregnancy was reported by Campbell 5 in 1947.…”

“…Renal rupture is a rare complication of pregnancy with a limited number of cases reported in the medical literature. [1][2][3] Spontaneous renal rupture is diagnosed when rupture occurs without recent surgery or trauma. 2,4 The concept of spontaneous renal rupture in the general population was introduced by Wunderlich in 1856, and the first case of urinary tract rupture during pregnancy was reported by Campbell 5 in 1947.…”