Fornix Rupture Research Articles

Renal Fornix Rupture Due To Acute Ureteral Obstruction

Background: Renal fornix rupture with fluid extravasation is a rare complication in cases of ureteral obstruction, which is usually caused by obstructive ureterolithiasis. The symptoms of renal fornix rupture are not very specific and can easily go unnoticed due to their underlying cause. Case representation: The present article reports a case of a patient of a 70-year-old, male, who was diagnosed with a ruptured renal fornix due to acute ureteral obstruction, following clinical assessment and a non-contrast CT scan. The proposed course of action was the endoscopic placement of a double J ureteral catheter. Conclusion: In the case described, the conservative treatment that was chosen by passing a double J catheter through the left ureter, for the patient proved to be an alternative to surgical treatment in the acute event, reducing the risk of possible complications from the operation. It was possible to conclude that although renal fornix rupture is a rare emergency with multiple etiologies, conservative treatment with urinary diversion using a double J ureteral stent was effective in solving the patient's acute condition.

A Feasibility Study on Clinical Utility, Efficacy and Limitations of 2 Types of Flexible and Navigable Suction Ureteral Access Sheaths in Retrograde Intrarenal Surgery for Renal Stones

To evaluate stone-free rate, device maneuverability, and complications after retrograde intrarenal surgery (RIRS) using 2 different sizes of flexible and navigable suction ureteral access sheaths (FANS). A retrospective analysis was performed for patients who underwent RIRS for renal stones of any size, number, and location between November 2021 and October 2022. Group 1 had FANS of 12 French. Group 2 had FANS of 10 French. Both sheaths have a Y-shaped suction channel. Tip of 10 French FANS has 20% more flexibility. Lithotripsy was achieved using either thulium fiber or high-power holmium lasers. A 5-point Likert scale was used to assess the performance of each sheath. There were 16 patients in Group 1 and 15 patients in Group 2. Baseline demographics and stone parameters were similar. Four patients in Group 2 had the same session bilateral RIRS. Sheath insertion was successful in all renal units but one. Ten French FANS had a higher percentage of excellent scores for ease of use, manipulation, and visibility. Neither of the sheaths had an average or difficult rating for all evaluation scales. A fornix rupture requiring prolonged stenting occurred in group 2. All patients were discharged within 24hours of surgery. One patient in each group visited the emergency department (analgesic treatment). There were no infectious complications. At 3 months, a computed tomography scan showed that the absence of residual fragments >2mm was significantly higher in Group 2 (94.7% vs 68.8%, P=0.01). The 10 Fr FANS showed a higher stone-free rate. There was no infectious complication using both sheaths.

НЕТРАВМАТИЧЕСКИЙ РАЗРЫВ ФОРНИКСА С ЭКСТРАВАЗАЦИЕЙ КОНТРАСТА

Purpose: Description of a clinical case of surgical treatment of nontraumatic rupture of the renal calyx fornix, with extravasation of contrast agent into the perirenal tissue. Material and methods: Provided surgical treatment to a patient with spontaneous rupture of the calyx fornix on the background of ureteral obstruction caused by a stone. Results: Considering the concomitant pathology in the form of obstructive pyelonephritis, it was decided to drain the upper urinary tract with an external stent. After 7 days, the patient underwent replacement of the external stent with the internal one. The patient underwent antibacterial, anti-inflammatory therapy, with a positive clinical, laboratory effect. Retrograde pyelography was performed 7 days later. Violations of the integrity of the cavity system of the left kidney were not revealed. The external stent was replaced with an internal one. After 2 months, ureterolitho-extraction was performed on the left. Conclusion: From the data of the world literature and our own experience, we can conclude that spontaneous, non-traumatic rupture of the fornix is an extremely rare, urgent urological disease. We assume that the development of this process is similar to the Burhave syndrome, since smooth muscle fibers are present in the esophagus as well as in the esophagus. In order to provide immediate assistance to such patients, it is necessary to urgently drain the upper urinary tract. Timely diagnosis of this condition requires rapid tactics in the form of immediate ultrasound, radiological diagnostic methods, as well as computed tomography. The operational manual on the removal of stones in this case should be postponed for 2–3 weeks.

Spontaneous Rupture of Renal Pelvis Secondary to Extrinsic Compression of Sigmoid Volvulus

Spontaneous rupture of the renal pelvis is one of the rare complications and is commonly known to occur secondary to obstructed distal ureteric calculus [1]. Malignant ureteric obstruction and bladder outlet obstruction are few other causes that could like to rupture of renal pelvis secondary to the back pressure changes [2]. Pregnancy is one of the non-renal extra-luminal causes of the spontaneous renal fornix rupture [3]. However, blowout of renal pelvis secondary to an obstructing bowel has not been reported earlier.

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

Urinothorax, another complication of bladder tumor: case report

BackgroundRupture of the fornix is a rare and serious urological complication of obstructive pathologies. The main cause is ureteral stone, but rarely a bladder tumor. Described complications of fornix rupture are superinfection, perirenal abscesses and even sepsis, but not urinothorax.Case presentationPatient of 56 years old, active and chronic smoker, was hospitalized for anemia and obstructive renal failure on a non-documented bladder tumor; clinically, he was presented with hematuria and an intense right loin pain associated with homolateral basithoracic pain and dyspnea. The CT scan without injection showed a right perirenal collection with bilateral renal dilatation on endo-vesical tumor and a right pleural effusion of less abundance. The ratio of pleural fluid creatinine to blood creatinine was greater than 1, confirming urinothorax. As an emergency, a percutaneous nephrostomy was performed. After clinical stabilization, the patient underwent a trans-urethral resection of the bladder and derivation by a double j stent. The ultimate evolution was favorable.ConclusionsBeyond the metabolic complications secondary to obstructions, mechanical complications, which can also be fatal, must be included.

Spontaneous rupture of the renal calyx secondary to dysfunctional voiding

Spontaneous pelvicalyceal/ureteral rupture due to abnormal bladder dynamics or urinary retention is rare with only a few cases reported. We report a case of spontaneous fornix rupture secondary to increased intravesical pressure caused by dysfunctional voiding in a young female with mental subnormality with paralytic ileus as a presenting symptom. The patient settled with double J stenting and catheterization. A literature review of the upper tract rupture due to bladder dysfunction/urinary retention is presented along with a discussion of management options and prevention.

Utility of transjugular renal biopsy as an alternative to percutaneous biopsy

Background and objectivesTransjugular renal biopsies (TRB) are an alternative when percutaneous ultrasound renal biopsy is contraindicated. Few sites are currently carrying out this procedure, with limited literature existing on the indications, complications and diagnostic yield thereof. The aim of the study is to analyze the indications, diagnostic yield, safety and complications of percutaneous transjugular renal biopsies in our site over the last 15 years. Material and methodsRetrospective descriptive study of all transjugular renal biopsies performed in our site, the Hospital Vall d’Hebron, between 2003 and 2018. For this, an exhaustive review of the clinical records of patients subjected to this procedure during the study period was conducted. Results56 TRBs were performed during the study period. Out of the patients, 31 were men (55.4%) and 25 were women (44.6%), with a median age of 62 years (IQ range 25–75 [52.5–69.5]). More than half presented with haematuria at the time of biopsy, with a median creatinine of 2.69mg/dL (IQ 25–75 [1.7–4.3]) and median proteinuria at 24h of 2000mg (IQ 25–75 [0.41–4.77]). The mean systolic blood pressure (SBP) and diastolic blood pressure (DBP) were 140±26mmHg and 75±15mmHg, respectively. The biopsy was carried out owing to acute kidney failure in 19 patients, chronic kidney disease in 12 patients and nephrotic syndrome in 10 patients; in 15 patients it was carried out for other reasons. The most frequent TRB indication was technical impossibility in 16 of 56 cases (including infracostal kidneys, obesity and COPD), alterations in haemostasis (n=6), thrombocytopenia (n=5) and solitary kidney (n=7). 12.5% of the biopsies were hepato-renal. Histological diagnoses were obtained in two thirds of the renal biopsies. The average number of cylinders obtained was 2.5±1.3, with the average number of glomeruli being 6.6±6.2. The most frequent histological diagnoses were IgA nephropathy, membranoproliferative glomerulonephritis and thrombotic microangiopathy. Three major complications were observed: fornix rupture and two transfusion requirements due to bleeding and subcapsular hematoma. ConclusionsIn our site, TRB allowed for a histological diagnosis in 2/3 of patients for whom percutaneous ultrasound renal biopsy is contraindicated. This allowed us to diagnose and subsequently treat said patients.

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

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.

Biopsia renal transyugular. La alternativa a la biopsia percutánea en pacientes de alto riesgo

Background and objectivesTransjugular renal biopsies (TRB) are an alternative when percutaneous ultrasound renal biopsy is contraindicated. Few sites are currently carrying out this procedure, with limited literature existing on the indications, complications and diagnostic yield thereof. The aim of the study is to analyse the indications, diagnostic yield, safety and complications of percutaneous transjugular renal biopsies in our site over the last 15 years. Material and methodsRetrospective descriptive study of all transjugular renal biopsies performed in our site, the Hospital Vall d’Hebron, between 2003 and 2018. For this, an exhaustive review of the clinical records of patients subjected to this procedure during the study period was conducted. Results56 TRBs were performed during the study period. Out of the patients, 31 were men (55.4%) and 25 were women (44.6%), with a median age of 62 years (IQ range 25-75 [52.5-69.5]). More than half presented with haematuria at the time of biopsy, with a median creatinine of 2.69 mg/dL (IQ 25-75 [1.7-4.3]) and median proteinuria at 24 hours of 2000 mg (IQ 25-75 [0.41-4.77]).The mean systolic blood pressure (SBP) and diastolic blood pressure (DBP) were 140 +/- 26 mmHg and 75 +/- 15 mmHg, respectively. The biopsy was carried out owing to acute kidney failure in 19 patients, chronic kidney disease in 12 patients and nephrotic syndrome in 10 patients; in 15 patients it was carried out for other reasons. The most frequent TRB indication was technical impossibility in 16 of 56 cases (including infracostal kidneys, obesity and COPD), alterations in haemostasis (n = 6), thrombocytopenia (n = 5) and solitary kidney (n = 7). 12.5% of the biopsies were hepato-renal. Histological diagnoses were obtained in two thirds of the renal biopsies. The average number of cylinders obtained was 2.5 ± 1.3, with the average number of glomeruli being 6.6 ± 6.2. The most frequent histological diagnoses were IgA nephropathy, membranoproliferative glomerulonephritis and thrombotic microangiopathy. Three major complications were observed: fornix rupture and two transfusion requirements due to bleeding and subcapsular hematoma. ConclusionsIn our site, TRB allowed for a histological diagnosis in 2/3 of patients for whom percutaneous ultrasound renal biopsy is contraindicated. This allowed us to diagnose and subsequently treat said patients.

Fornix Rupture in Duplex Kidney due to Internal Iliac Artery Aneurysm.

A 70-year-old man presented with severe pain on the right side of the abdomen for 7 days. An abdominal CT angiographic scan showed an impending rupture of a large right internal iliac artery aneurysm which compressed to a right ureter causing hydroureteronephrosis. Fornix rupture of a right duplex kidney was also detected. Selective embolization of right gluteal arteries and then ligation of the right internal iliac artery and right ureterotomy with double J stenting were performed. At the 4-month follow-up appointment, an abdominal ultrasound demonstrated a decrease in the size of the aneurysm and no hydroureteronephrosis after the removal of double J stent.

Spontaneous Fornix Rupture Due to Obstructive Ureteral Stone

Spontaneous Fornix Rupture Due to Obstructive Ureteral Stone

Urétéro-hydronéphrose avec rupture du fornix sur masse ovarienne suspecte

Extravasation of urine following rupture of the renal fornix is a rare complication mostly caused by obstruction secondary to distal ureteric stones. This 35-year-old woman was referred with back pain. Her CT scan revealed rupture of the renal fornix secondary to a pelvic mass. Laparoscopy subsequently confirmed this to be an ovarian abscess. We report the first case of spontaneous renal forniceal rupture secondary to pelvic inflammatory disease.

Die Nierenkolik in der allgemein-internistischen Praxis

Based on the prevalence of asymptomatic kidney stones (5% in our general ward, in accordance with the literature) the value of abdominal ultrasonography in the clinical assessment of a suspected kidney-colic is discussed. The eminent importance of the stone-analysis is emphasized. In addition, the most common causes of kidney stone formation (low urine output, mechanical urinary obstruction in the renal pelvis, hypercalciuria, hyperoxaluria, insufficient urinary citric acid excretion, hyperuricosuria) are highlighted. The cardinal symptom of the urolithiasis is the presence of micro/macrohematuria (which is often absent - according to citations - in 20-80%!). Moreover, the differential diagnosis of acute flank pain, as neoplastic- or infectious diseases, reno-vascular and extrarenal causes (retro-peritoneal and mesenteric vascular processes and rupture of abdominal aneurysms), gynecological problems (e.g. rotation/rupture of ovarian cysts, ectopic pregnancy), appendicitis, diverticulitis, and splenic abscess/infarction, as well as hepato-pancreaticobiliary causes are discussed. Moreover, metabolic syndromes, e.g. the intermittant porphyria or infectious diseases (e.g, Fitz-Hugh-Curtis syndrome) and other rare pathologies (such as the «Mediterranean fever») may be at the origin of acute flank pains. A particular attention is given to possible diagnostic procedures in a primary care setting: in addition to medical history, clinical status and specific laboratory findings the value of diagnostic ultrasound, with special reference to the color-Doppler application, as the «twinkling artefact» from kidney stones and the «urinary-jet phenomenon» for the assessment of urinary outflow obstruction, is emphasized. In this context we point out that a lack of dilatation of the kidney pelvis never excludes a kidney-colic, on the other hand, a dilatation of the kidney pelvis does not necessarily mean congestion! The conservative treatment strategies (avoidance of excessive drinking - an obstructed kidney protects itself - NSAID in combination with Tamsulosin, especially in case of prevesical urolithiasis) are discussed. The critical stone size (≤5 mm) and the absence of «red flags» (especially obstructive and inflammatory signs) allow a non-specialist medical outpatient treatment of acute nephro-and ureterolithiasis. The possible complications of the urolithiasis, especially the urosepsis and the (iatrogenic) fornix rupture are highlighted, as well as the formation of a renal abscess or hydronephrosis. A short look is given to the metaphylaxis of the urolithiasis and its «recurrence rate».

The Spontaneous Rupture of the Renal Fornix Caused by Obstructive Nephropathy

A 62-year-old woman presented to the Emergency Department with right flank pain and decreased urine output for 3 days. She had a history of advanced gastric cancer. The patient had undergone radical total gastrectomy with Roux-en-Y esophagojejunostomy 4 months previously. She had pain and tenderness in the right flank area. On initial physical examination, she was alert but appeared chronically ill. The abdomen was soft and flat without palpable mass. She had no direct or rebound tenderness on the entire abdomen. However, she had tenderness on the right costovertebral angle. Her vital signs were as follows: temperature 36.4 C, blood pressure 130/85 mm Hg, pulse rate 108 beats/min, and respiratory rate 15 breaths/min. The laboratory results revealed the following: white blood cell count was 12,980/mm with 91.1% segmented neutrophil; the hemoglobin was 10.5 g/dL, blood urea was 14.4 mg/dL, and creatinine was 0.86 mg/dL. Electrolytes, hepatic function panel, coagulation studies, and lipase were within normal limits. The urinalysis showed 1+ red blood cells, trace leukocyte, and negative nitrite. The plain radiographs were unremarkable. An emergency ultrasound revealed fluid collection in the hepatorenal recess and hydronephrosis of the right kidney (Figure 1). A contrast-enhanced computed tomography

Renal fornix rupture following diagnostic coronarography

A 31-year-old man with an uneventful medical history presented at the emergency department with complaints of exercise-related chest pain for 3 weeks. ECG showed ST-elevations in the inferior leads. A diagnostic coronarography was performed and showed multivessel coronary stenosis. During this procedure 200 ml of a nonionic, low-osmolality monomeric contrast agent (Iomeron 350®) and 1250 ml of isotonic saline solution was administered intravenously. After this procedure, the patient suffered from a sudden onset and progressive severe pain in the back and the right lumbar region. A plain CT of the abdomen performed 8 hours post coronarography showed contrast enhanced fluid in the renal sinus and the perinephric/peri-ureteral space (Fig. A (scout view), B (coronal) and C (sagittal) reformatted scans). There was a bladder overdistenstion with a CT-based volumetric estimation of 995 ml. No mechanical cause of upper urinary tract obstruction was present. Subsequent urological work-up included insertion of a bladder catheter (24 hours) and administration of peroral antibiotics. Ultrasound follow-up on the next day revealed no abnormalities and the patient was discharged.

Transitional cell carcinoma of ureter presenting acute ureteric colic and ruptured caliceal fornix with extravasation of urine

Abstract Background: Primary ureteral tumors are not common. The most common presentations of upper urinary tract urothelial carcinoma are gross or microscopic hematuria. Objective: Report a rare case of acute ureteric colic with perirenal urinoma, secondary to primary ureteric carcinoma. Methods: Case report and review of literature. Result: Perirenal extravasation and ureteric obstruction by tumor was diagnosed by contrast-enhanced computed tomography. The patient was successfully treated with laparoscopic radical nephroureterectomy after the obstruction was relieved by ureteric stent. Adjuvant radiation was done at the renal fossa for local control. There was no evidence of disease recurrence at twelve month after surgery. Conclusion: The renal caliceal fornix rupture is usually associated with acute ureteric obstruction by stone. Rarely, it occurs by primary ureteric tumor.

Outcome Analysis of Fornix Ruptures in 162 Consecutive Patients

Fornix rupture is a potential urologic emergency. In most cases, ureteral stones represent the underlying cause. Management of a fornix rupture is not standardized. In a retrospective analysis, we investigated 162 patients who had received a diagnosis of fornix rupture between 1994 and 2005. In all patients, the diagnosis was based on radiographic investigations with application of contrast media. We evaluated the parameters' underlying cause, associated symptoms, diagnostic and therapeutic procedures, and outcome in patients with a fornix rupture. There were 121 men and 41 women with a median age of 53 years (range 20-79 years). In 93.2% of patients, one or more symptoms were present at diagnosis. In 59.9% of cases, a ureteral stone was diagnosed; in 12.3%, the underlying cause was different; and in the remaining 27.8% of patients, no reason for a fornix rupture was found. In all patients, primary endoscopic therapy (96.3%) or insertion of a nephrostomy tube (3.7%) was performed. All patients had a bladder catheter inserted, and antibiotic treatment was given in 92% of patients. A renal or perirenal abscess or other secondary complications necessitating open operative revision did not develop in any patient. The retrospective manner is a limitation of our study. Comparison of subgroups may therefore be biased. Ureteral stones are the most frequent causes of a fornix rupture. With a low pressure system and antibiotic treatment, the outcome is excellent, and secondary complications can be effectively prevented. Parameters for conservative treatment are to be defined to reduce overtreatment of certain patients with a fornix rupture.

Ursachen und Verlauf bei Fornixruptur

Fornix rupture is a urological emergency situation. In most cases ureteral stones represent the underlying cause. We present the largest series ever reported. Between 1994 bis 2005 a total of 162 patients were diagnosed with a fornix rupture. There were 121 men and 41 women with a median age of 53 years (range: 20-79 years). We investigated the following parameters: underlying cause of fornix rupture, symptoms, diagnostic and therapeutic procedures. In 60% of cases a ureteral stone was found as cause and in another 28% we found no reason for fornix rupture. 93% of patients had one or more symptoms at the time of diagnosis. In all patients primary endoscopic therapy (96%) or insertion of a nephrostomy tube was performed (4%). Also, antibiotic treatment was given in 92% of patients. No patient developed a perirenal abscess or other relevant complication requiring open operative revision. We confirm that ureteral stones are the most frequent causes of fornix rupture. With a low pressure system and antibiotic treatment, secondary complications can be effectively prevented.

Iatrogenic fornix rupture caused during retrograde manipulation of the ureter: a case report

Iatrogenic fornix rupture caused during retrograde manipulation of the ureter is a rather rare or rarely diagnosed phenomenon. A 22 year-old female patient presented with a fornix rupture following endoscopic ureteral stone extraction under uretero-renoscopy, the rupture having become symptomatic two days later.