Forniceal Rupture Research Articles

Predictors of forniceal rupture in patients with obstructing ureteral calculi: Analysis of multicenter data.

Renal forniceal rupture (FR) is a unique complication of obstructive uropathy. This study aimed to identify the predictors of FR among patients presenting with renal colic due to obstructing ureteral calculi. After obtaining ethics approval, electronic records of patients from three National Guard hospitals in Saudi Arabia were reviewed between 2016 and 2020 to identify patients who presented with renal colic and were diagnosed with FR due to obstructive ureteric stones (FR group). An equivalent number of consecutive patients presenting with renal colic due to obstructing ureteric stones without FR was selected as a control group (non-FR group). Patients were grouped according to age group (<30, 30-40, 41-50, and >50 years), body mass index (BMI) class, gender, comorbidities, grade of hydronephrosis, location of the stone in the ureter, size of the stone (<3 mm, 3-7 mm, and >7 mm), and stone former status. Baseline patients' and stone characteristics were compared, and a regression analysis was performed to identify predictors of FR. A total of 50 patients with FR were identified, and a control group of 50 patients without FR were selected. The baseline patients' and stone demographic characteristics in terms of age (P = 0.42), gender (P = 0.275), BMI (P = 0.672), comorbidity, grade of hydronephrosis (P = 0.201), and stone location (P = 0.639) were comparable between the FR group and the non-FR group. However, the stone size was statistically significant between both groups (P = 0.014). On multivariable analysis, it was found that the stone size was associated with a significantly higher increase in the incidence of FR (odds ratio [OR]: 6.5 [1.235-34.434]; P = 0.027). Furthermore, the age group between 30 and 40 years was potentially at a lower risk for FR (OR: 0.262 [0.069-0.999]; P = 0.049). This multicenter study showed that the stone size 3-7 mm had a six-fold increase in the chance of FR, and the age group between 30 and 40 years is potentially at a lower risk for FR.

Imaging of Perirenal and Intrarenal Lymphatic Vessels: Anatomy-based Approach.

The lymphatic system (or lymphatics) consists of lymphoid organs and lymphatic vessels. Despite the numerous previously published studies describing conditions related to perirenal and intrarenal lymphoid organs in the radiology literature, the radiologic findings of conditions related to intrarenal and perirenal lymphatic vessels have been scarcely reported. In the renal cortex, interlobular lymphatic capillaries do not have valves; therefore, lymph can travel along the primary route toward the hilum, as well as toward the capsular lymphatic plexus. These two lymphatic pathways can be opacified by contrast medium via pyelolymphatic backflow at CT urography, which reflects urinary contrast agent leakage into perirenal lymphatic vessels via forniceal rupture. Pyelolymphatic backflow toward the renal hilum should be distinguished from urinary leakage due to urinary injury. Delayed subcapsular contrast material retention via pyelolymphatic backflow, appearing as hyperattenuating subcapsular foci on CT images, mimics other subcapsular cystic diseases. In contrast to renal parapelvic cysts originating from the renal parenchyma, renal peripelvic cysts are known to be of lymphatic origin. Congenital renal lymphangiectasia is mainly seen in children and assessed and followed up at imaging. Several lymphatic conditions, including lymphatic leakage as an early complication and acquired renal lymphangiectasia as a late complication, are sometimes identified at imaging follow-up of kidney transplant. Lymphangiographic contrast material accumulation in the renal hilar lymphatic vessels is characteristic of chylo-urinary fistula. Chyluria appears as a fat-layering fluid-fluid level in the urinary bladder or upper urinary tract. Recognition of the anatomic pathway of tumor spread via lymphatic vessels at imaging is of clinical importance for accurate management at oncologic imaging. ©RSNA, 2024 Test Your Knowledge questions for this article are available in the supplemental material.

Safety and feasability of ureteroscopy for pediatric stone, in children under 5 Years (SFUPA 5): A French multicentric study

Ureteroscopy (URS) can be proposed as first-line therapy for the management of pelvic stones from 10 to 20mm and for lower ureteric stones in children. However, little is known about the success and the morbidity of URS in young children. Ureteroscopic treatment may present matters in young children because of the small size of the pediatric kidney and the small size of the collecting system. To assess safety and efficacy of URS for the treatment of urinary stones in children aged of 5 years or less. After the institutional ethical board approval was obtained, we conducted a retrospective, analytic, multicentric study that included all URS performed between January 2016 and April 2022 in children aged of 5 years or less. In this non-comparative case series, anonymized pooled data were collected from 7 tertiary care centers of pediatric patients. Endpoints were the one-session SFR at 3 months and per and postoperatives complications. Descriptive statistics were applied to describe the cohort. Eighty-three patients were included. For them, 96 procedures were performed at the median age of 3.5 years (IQR: 0.8-5) and median weight of 14Kg (6.3-23). Median stone size was 13mm (4-45). There were 65 (67 %) renal stones treated with flexible URS, most of which were in the renal pelvis (30 %) and in the lower calix (33 %). A ureteral access sheath was used in 91% procedures. Preoperative ureteral stent was placed in 52 (54 %) of patients. None of patients had ureteral dilatation. The single-session SFR was 67.4 % (56.3 and 89.2% for flexible URS and semi-rigid URS respectively) and children require 1.4 procedures to achieve complete stone clearance. The overall complication rate was 18.7 %, most of them were minor (Clavien I-II). Intraoperative perirenal extravasation (Clavien IIIb) due to forniceal rupture was documented in 6.2% of cases, related to an increased intrapelvic pressure (IPP) performed in a closed pelvicalyceal system. Pediatric urologists should be aware of forniceal rupture based on the presence of extravasation of contrast during endourological procedures especially when they have difficulties to reach lower caliceal stone in small patient. URS in patients aged of 5 years or less, is a complex minimally invasive procedure with reasonable efficacy and low morbidity. Intrarenal stones treated by RIRS in young children carries the risk of additional procedures to complete stone clearance.

Obstructing Urolithiasis Leading to Renal Forniceal Rupture

Obstructing Urolithiasis Leading to Renal Forniceal Rupture

Determining the threshold of acute renal parenchymal damage for intrarenal pressure during flexible ureteroscopy using an in vivo pig model.

To identify a threshold for intrarenal pressure (IRP), that if exceeded, will result in renal parenchymal damage. Herein, we attempt to identify an IRP threshold by subjecting in vivo porcine kidneys to various levels of extreme pressurized irrigation. Our objective was not to simulate ureteroscopy treatment, but to attempt identify a threshold of IRP injury. Ten female pigs were intubated and sedated. The abdomen was opened; the ureters were isolated and incised. A LithoVue™ (Boston Scientific) ureteroscope was inserted. A 0-silk tie was then used to tie the ureter around the scope to create a closed system (to achieve a constant level of pressure). Real-time IRPs were measured using the Comet™ Pressure guidewire (Boston Scientific). Kidneys were exposed to pressurized, saline for 36min (at control, 50, 100, 150mmHg and higher pressures). Kidneys were then immediately harvested. Two expert histologists independently analyzed kidney slides to identify areas of renal damage. The two kidneys exposed to IRPs > 185mmHg resulted in forniceal rupture and large areas of hematoma. The other IRP groups (control, 50, 100, and 150mmHg) had no identifiable gross or histologic renal parenchymal damage. No differences in renal parenchymal morphology were identified between pressure groups of control, 50, 100, or 150mmHg. However, IRPs > 185mmHg did result in forniceal rupture in this closed-system in vivo porcine model. Further study is required to elucidate the damage threshold.

PD37-03 DETERMINING THE THRESHOLD OF SAFETY FOR INTRARENAL PRESSURE DURING FLEXIBLE URETEROSCOPY USING AN IN VIVO PIG MODEL

You have accessJournal of UrologyCME1 May 2022PD37-03 DETERMINING THE THRESHOLD OF SAFETY FOR INTRARENAL PRESSURE DURING FLEXIBLE URETEROSCOPY USING AN IN VIVO PIG MODEL Matthew Lee, Deepak Agarwal, Bret Connors, Mark Assmus, James Williams, Tim Large, and Amy Krambeck Matthew LeeMatthew Lee More articles by this author , Deepak AgarwalDeepak Agarwal More articles by this author , Bret ConnorsBret Connors More articles by this author , Mark AssmusMark Assmus More articles by this author , James WilliamsJames Williams More articles by this author , Tim LargeTim Large More articles by this author , and Amy KrambeckAmy Krambeck More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002595.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Ureteroscopy (URS) is the most commonly performed surgery for kidney stones. Multiple studies have investigated what intrarenal pressures (IRPs) occur during URS. However, no one has attempted to identify a threshold for IRP, that if exceeded, will result in renal parenchymal damage. Herein, we attempted to identify this IRP safety threshold by subjecting in vivo porcine kidneys to various levels of pressurized irrigation. METHODS: 10 female pigs (60–80 kg) were intubated and sedated. The abdomen was opened with electrocautery and the ureters were isolated and opened. We inserted a LithoVue (Boston Scientific) ureteroscope into the ureter and advanced it up to the kidney. An 0-silk tie was then used to tie the ureter around the scope to create a closed system so we could subject the kidney to a maximum level of pressure. Realtime IRPs were measured using the Comet Pressure Wire (Boston Scientific). Kidneys were subjected to various levels of pressure (0, 50, 100, and 150 mmHg) for 36 minutes (based on published mean URS times). The control arm had 3 kidneys and each pressure group had 5 kidneys. Kidneys were then fixed using an intravascular perfusate and harvested. Two expert pathologists then independently analyzed kidney slides (H&E staining and picrosirius red) to identify areas of renal damage. RESULTS: The differences in mean IRPs between the groups was significant (p <0.0001). Two kidneys were exposed to IRPs >185 mmHg as we initially planned to have a 300 mHg group. We identified that IRPs greater than 185mmHg routinely resulted in forniceal rupture. Kidneys subjected to pressures >185 mmHg developed large areas of hematoma. We did not find any differences in renal parenchymal damage. CONCLUSIONS: No differences in renal parenchymal damage were identified between pressure groups of 50, 100, or 150 mmHg. However, IRPs >185 mmHg did result in forniceal rupture. Source of Funding: Boston Scientific © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e639 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Matthew Lee More articles by this author Deepak Agarwal More articles by this author Bret Connors More articles by this author Mark Assmus More articles by this author James Williams More articles by this author Tim Large More articles by this author Amy Krambeck More articles by this author Expand All Advertisement PDF DownloadLoading ...

POS-005 severe hydronephrosis with forniceal rupture secondary to obstructive nephropathy

spontenious rupture of the renal fornix is an uncommonly encountered pathology that has been scarcely reported. It is of mecanical origin in case of acute obstruction. In chronic pathologies, there is a progressive appearance of hydronephrosis in relation with urine reflux in the pyelocalicial pathway that would have an irritating effect on the urothelial tissu and renal parenchyma causing then an inflammatory reaction and fibrosis

Spontaneous rupture of pyonephrosis presenting as anterior abdominal wall abscess: a rare case report

BackgroundA pyonephrosis caused by an obstructing calculus is typically accompanied by fever, loin pain, and other signs of urinary tract infection. Occasionally, severe thinning of the renal parenchyma in pyonephrosis allows direct forniceal rupture into the retroperitoneum and very rarely into the anterior abdominal wall, misconstruing it as an isolated abdominal wall abscess.Case presentationDiabetes-related 55-year-old diabetic male presented with abscess in his periumbilical region extending into right lumbar region. He did not exhibit any urinary symptoms, and contrast enhanced computed tomography [CECT] abdominal and pelvic examinations revealed right pelvic calculus with pyonephrosis. There is a 7.5 mm defect in the lower pole of the right kidney with 171 cc of collection adjacent to the kidney communicating with 150 cc of superficial abdominal wall collection through a 15 mm defect. Incision and drainage of abdominal and retroperitoneal abscesses were done at first. Right DJ stenting was performed. Right lateral decubitus was placed for dependent drainage. Resolution of residual collections was confirmed by subsequent ultrasonography KUB, and drain was then removed. Right DJ stenting done, and patient was discharged. Two months later, DTPA scan done and revealed GFR of 30 ml/min of right kidney. Patient underwent right percutaneous nephrolithotomy.ConclusionThe sudden rupture of pyonephrosis is a rare event. Even rarer is the presentation of pyonephrosis as an abscess on the anterior abdominal wall. The correct diagnosis and search for the source of the abscess must be undertaken before intervention. An aggressive and prompt management is needed to prevent further complications from occurring. This case is being presented to add to the literature with regard to abnormal presentations of ruptured pyonephrosis and its management.

A Rare Case of Pseudotumoral Ureteric Tuberculosis Causing Forniceal Rupture

A 55-year-old woman, with no medical history, presented with acute right flank pain. She had no history of other urinary complaints. On physical examination, the patient was tachycardic (pulse rate: 100bpm) and tachypneic (respiratory rate: 24 breaths/min), blood pressure was11/6 and temperature was 37.4°. The abdominal examination showed severe tenderness in the right flank and the right iliac fossa. All blood reports were normal, including C-reactive protein, cell blood count and serum creatinine. Computed Tomography of the abdomen revealed a right hydronephrosis with delayed phase contrast leak and a retroperitoneal mass of 48x36mm of unknown nature, enhanced after contrast injection, which seemed to compress the right ureter causing the forniceal rupture. A double J ureteral stent was insterted into the right renal cavities with favorable evolution and immediate resolution of pain. Surgical management of the mass was scheduled one month later after the inflammatory phase and resorption of the urinoma. The patient underwent an exploratory laparotomy. Intraoperatively, a tissular retroperitoneal mass of 4 cm was discovered which invadedthe right proximal ureter as well asthe duodenum and the ileocecal pedicle (Figure 1). Resection of the tumor was performed as well as a segmental ureterectomy, right colectomy, and resection of a small portion of the duodenum. Both ureteric and colic anastomosis were then performed along with duodenal suture. The post operative course was uneventful.

Case Report: Not Your Typical Kidney Stone.

Flank pain, forniceal rupture, renal colic, CT scan.

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

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.

Predicting emergency interventions in patients with acute ureteral colic using acute renal colic scoring system in a Pakistani cohort.

To evaluate the acute renal colic score (ARC) in predicting the need of emergency intervention (EI) in patients with ureteric colic secondary to a ureteral stone. In an emergency room (ER) of a university hospital, we conducted a prospective cohort study over a period of 6months. ARC score was calculated using four parameters, i.e., serum creatinine, total white cell count (TLC), stone length and level. Primary outcome measure was EI, which was defined as the need of endourological intervention within 48h of presentation. ARC was calculated for each patient against the two possible outcomes, i.e., EI vs. no EI. The need of intervention was based on patient-related clinical factors and the decision of the attending urologist. The study included 132 patients. EI was performed in 85 patients (64.4%). URS was the most common intervention performed in 81 (95.3%) patients, followed by the a insertion of a double J stent in two (2.4%) patients for forniceal rupture and high TLC count and percutaneous nephrostomy in two (2.4%) patients for raised creatinine and TLC. All four variables in ARC score including serum creatinine (p < 0.001), TLC (p < 0.001), stone size (p < 0.001) and stone level (p < 0.001) were found to be significantly associated with need for EI. Using ROC the sensitivity and specificity of the score was 92.9% and 87.5%, respectively, with AUC of 0.93. ARC score is highly sensitive and specific in determining the need of EI in patients with uncomplicated ureteric colic within 48h of initial presentation.

Forniceal Rupture in Neonate Masquerading as a Cystic Renal Mass

A 5-week-old full-term female with high-risk right hydronephrosis was transferred to the emergency department (ED) for tachypnea. A contrast-enhanced computed tomography (CT) study demonstrated a 9.0 cm cystic lesion in the region of the previously seen hydronephrosis (Fig. 1). Urology was consulted to rule out a cystic neoplasm, which on review of imaging was more suggestive of a contained forniceal rupture. An ultrasound-guided percutaneous nephrostomy tube drained 200 cc of urine. Culture and cytology were negative. Respiratory status markedly improved. The patient was discharged with outpatient follow to evaluate for ureteropelvic junction obstruction.

MP22-01 A RETROSPECTIVE COHORT COMPARISON OBSTRUCTING URETERAL STONES WITH FORNICEAL RUPTURE (FROU) VS NO FORNICEAL RUPTURE (NOFROU)

INTRODUCTION AND OBJECTIVE:Forniceal rupture due to obstructing ureterolithiasis (FROU) is a seldom encountered radiographic finding but the impact of this diagnosis and influence on stone manageme...

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

Introduction and Objective: Forniceal rupture due to obstructing ureterolithiasis (FROU) is a seldom encountered radiographic finding, but the impact of this diagnosis and influence on stone management has not been well studied in the literature. The purpose of the study is to examine stone characteristics and intervention patterns of patients with radiographic evidence of FROU. Materials and Methods: A retrospective analysis of all patients with radiographic evidence of FROU was compared with patients with obstructing ureteral stones without forniceal ruptures (noFROU). All patients presented to our Emergency Department from January 2015 until December 2018. Data analyzed included patient demographics, clinical presentation, stone characteristics, and management pattern. Primary outcome was need for hospital admission and surgical intervention. Results: Thirty-two patients with FROU (mean age = 45) were compared with 50 patients with noFROU (mean age = 57). Univariate analysis revealed that age, history of diabetes mellitus, history of hypertension, days of symptoms, degree of hydronephrosis, and degree of perinephric stranding were associated with forniceal rupture (p ≤ 0.05). On multivariate analysis, only degree of perinephric stranding remained significant (p ≤ 0.05). Average maximum axial stone diameter in the FROU group was 5.1 mm vs 4.7 mm in the noFROU group (p = 0.66). Overall, 68.8% of stones were located within the distal ureter in the FROU group vs 48.8% in the noFROU group (p = 0.09). There was no difference in hospital admission (FROU 37.5% vs noFROU 44%, p = 0.56) and need for surgical intervention (FROU 50% vs noFROU 48%, p = 0.86). There were no 30-day complications in patients with FROU. Conclusions: Ureteral stone location and size does not seem to impact the presence of FROU. FROU may be an alarming reported finding but its presence does not appear to impact clinical outcomes or affect urological management, including admission or need for urologic intervention.

Bilateral renal forniceal rupture due to retroperitoneal hematoma after femoral venous access

Retroperitoneal hematoma is a potential complication of femoral venous access that rarely leads to bilateral ureteral obstruction. We present the case of a 73-year-old woman who underwent an ablation procedure for atrial fibrillation complicated by laceration of an aberrant obturator artery during femoral venous cannulation, leading to a compressive retroperitoneal hematoma, bilateral ureteral obstruction, acute renal failure, and renal forniceal rupture. The patient was successfully treated with embolization of the inferior epigastric artery and aberrant obturator artery, hematoma evacuation, and ureteral stent placement. This case illustrates a rare complication of arterial laceration during femoral venous access without ultrasound guidance.

A CASE OF URINOTHORAX

SESSION TITLE: Wednesday Fellows Case Report Posters SESSION TYPE: Fellow Case Report Posters PRESENTED ON: 10/23/2019 09:45 AM - 10:45 AM INTRODUCTION: A urinothorax is a rare cause of pleural effusion which can occur in urinary obstruction or from trauma to the genitourinary system. We present a case of urinothorax in a patient with bilateral hydronephrosis. CASE PRESENTATION: A 70 year old female with metastatic cholangiocarcinoma presented with abdominal pain, anuria, and shortness of breath for three days. She was found to have an acute kidney injury with bilateral hydronephrosis and left sided forniceal rupture. Physical examination also revealed decreased breath sounds over the left hemithorax. Chest imaging revealed complete opacification of the left hemithorax with mediastinal shift to the right. She was admitted to the intensive care unit and a diagnostic and therapeutic thoracentesis was performed with removal of 1.9L of straw colored transudative fluid. Pleural fluid creatinine was 12.6. The pleural fluid creatinine to serum creatinine ratio was >1. Bilateral percutaneous nephrostomy tubes were placed and renal function and urine output improved. Chest imaging done two months later did not show any re-accumulation of pleural effusion. DISCUSSION: A urinothorax is an uncommon complication of obstructive uropathy and genitourinary tract abnormalities that can occur in malignancy or traumatic injury. It is typically a unilateral, straw-colored effusion with a pH lower than 7.40 and transudative in nature by Light’s criteria. A urinothorax has two possible mechanisms. Urine can collect in the retroperitoneal space if an obstruction is present and the fluid enters the peritoneal cavity and thereafter leaks through transdiaphragmatic holes into the pleural space. Urine may also travel through lymphatics into the pleural cavity. A high degree of clinical suspicion is needed to make the diagnosis. In patients with concomitant urinary tract infections, especially with ammonia producing organisms, the effusion may be exudative as well as having a pH higher than 7.40, thereby confusing the clinical picture. A pleural fluid creatinine to serum creatinine ratio of greater than 1 clinches the diagnosis of a urinothorax. Further confirmatory workup can be done with a renal scintigraphy study to reveal extravasation of urine from the genitourinary system into the pleural space. Treatment of a urinothorax is aimed at the management of the underlying genitourinary condition. CONCLUSIONS: A urinothorax should be included in the differential diagnosis in a patient with obstructive uropathy or recent surgical genitourinary interventions presenting with a pleural effusion. The condition is completely reversible after treatment of the underlying cause. Reference #1: Handa A, Agarwal A, Aggarwal AN. Urinothorax: an unusual cause of pleural effusion. Singapore Med J 2007; 48(11):e289–e292 Reference #2: Chandra A, Pathak A, Kapur A, Russia N, Bhasin N. Urinothorax: A rare cause of severe respiratory distress. Indian J Crit Care Med. 2014 May; 18(5): 320–322. Reference #3: Garcia-Pachon E, Romero S. Urinothorax: a new approach. Curr Opin Pulm Med. 2006; 12: 259-263 DISCLOSURES: No relevant relationships by Sujith Cherian, source=Web Response No relevant relationships by Rosa Estrada-Y-Martin, source=Web Response No relevant relationships by Bibi Aneesah Jaumally, source=Web Response

Etiology and Treatment of Renal Forniceal Rupture: A Single Center Experience

Etiology and Treatment of Renal Forniceal Rupture: A Single Center Experience

Renal Forniceal Rupture: Is Conservative Management Safe?

To outline treatment considerations and outcomes for a cohort of patients with forniceal rupture with the aim of adding to a very limited body of literature regarding clinical practice in this area. We retrospectively searched all radiographic records for patients treated at our institution between January 2009 and January 2016 with forniceal rupture. We compiled demographic data, etiology, clinical factors, treatments, and outcomes. Of the 103 patients analyzed, the median age at presentation was 64 years (interquartile range 52-73), and 56 (54%) were female. The etiology of forniceal rupture was most commonly urolithiasis (73%), with cancer being the next most common cause (11%). Most cases (61%) were caused by small (1-5 mm) stones in the distal ureter. Thirty-one patients (30%) were treated surgically with ureteral stent placement upfront; 27 of those patients had a ureteral stone, and most had some clinical factors making them higher risk. There was only 1 operative complication during the study period. Only 1 patient developed an abscess. Forty-three patients (42%) were sent home from the emergency room. Of the patients who were admitted, the average hospital stay was 3 days (interquartile range 2-6). For the entire cohort, there were 6 (6%) readmissions in the study period. Very limited data exist in the literature regarding clinical practice in the treatment of forniceal rupture. Clinical practice at our institution is conservative treatment of forniceal rupture in the absence of infection, kidney failure, or other risk factors with few complications or readmissions.

Spontaneous forniceal rupture: Can it be treated conservatively?

Context:Spontaneous forniceal rupture is one of the possible complications of urolithiasis. The mechanism of forniceal rupture is not well explained in the literature. Most of the cases presented with sudden onset of acute renal colic and diagnosed by noncontrast CT (NCCT). Until now there is no solid consensus about the ideal management of such a condition.Aim:To study indications and validity of conservative management of spontaneous caliceal rupture.Settings and Design:This is an observational prospective study.Materials and Methods:All cases diagnosed as spontaneous forniceal rupture in our departments from 2011 to 2015 were enrolled. All cases were diagnosed with NCCT or CT-Urography.. Non complicated patients were primarily managed conservatively. Intervention (DJ stent insertion, nephrostomy tube insertion, or urgent ureteroscopy) was reserved to complicated cases or solitary kidney. Drainage of urinoma was done in cases with sizable urinoma (more than 100 ml3).Results:A total of 40 patients: Twenty eight (70%) patients had normal serum creatinine level at presentation, while 12 (30%) patients had elevated serum creatinine. Twenty three (57.5%) patients were successfully managed conservatively, their mean size of stone was 6.2 ± 2 mm and the hospital stay was 3.1 ± 1.9 days. Eighteen patients (42.5%) underwent interventions. Their stone size was 4.5 ± 2.1 mm and the hospital stay for the interventional group was 4.2 ± 1.8 days.Statistical Analysis Used:Mann-Whitney test was used for testing difference between means because the data groups are not parametric. Otherwise, simple descriptive statestics were used.Conclusion:Spontaneous forniceal rupture is more likely to occur with smaller distal ureteric stones. Conservative management is a valid option in non-complicated cases. Intervention should be reserved to complicated cases or cases with sizable urinoma.