Abstract
BackgroundSpontaneous 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.MethodsA 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.ResultsA 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 post-natal 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.ConclusionWhile 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.
Highlights
Spontaneous renal fornix rupture (SRFR) causing urinoma is an uncommon but serious condition in pregnancy
Literature search Following a review of 1579 database entries and removal of 343 duplicates and other entries (1175 due to not meeting exclusion criteria), 39 articles were eligible for final inclusion in the analysis (Fig. 1)
We present, to our knowledge, the first systematic review conducted to assess the diagnosis, management and outcomes relating to SRFR in pregnancy
Summary
Spontaneous renal fornix rupture (SRFR) causing urinoma is an uncommon but serious condition in pregnancy. The aim of this study was to determine the natural history and outcomes of SRFR to determine appropriate management recommendations. The renal fornix is the most common site for spontaneous perforation or rupture, followed by the upper ureter [1]. Spontaneous renal fornix rupture (SRFR) is often encountered in urological practice due to the presence of ureteral calculi, extrinsic compression from malignancy or mass, and instrumentation [2, 3], but is otherwise uncommon in their absence [4]. Whilst flank pain and pyelonephritis secondary to over distension are common manifestations of this physiologic phenomenon, rupture of the renal collecting system may rarely occur, especially with excessive intraluminal pressures [1]
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