Rupture Of Ureter Research Articles

Evaluation and Management of Urological Complications Following Pediatric Kidney Transplantation: Experience from a Single Tertiary Center

Background/Objectives: Kidney transplantation is the treatment of choice for children with end-stage renal disease (ESRD), but its outcome can be affected by urological complications, with incidence rates of 2.5–25%. The aim of this study was to evaluate the occurrence of urological complications and their management in a cohort of pediatric kidney transplant recipients. Materials and Methods: A retrospective analysis on 178 patients who received a renal transplant at our Pediatric Kidney Transplant Center between 2011 and 2023 was conducted. Demographic and clinical data were analyzed. Urological complications were categorized as early, intermediate, or late based on their onset time. Results: Out of 178 patients, 28 (15.7%) experienced urological complications. Most patients (61%) had a pre-existing uropathy. Early complications (7–30 days) were all obstructive, namely, ureterovesical junction obstruction and perirenal collections. Intermediate complications (1–3 months) comprised ureteral stenosis, symptomatic vesicoureteral reflux (VUR), and obstructive lymphocele. Late complications (>3 months) included symptomatic VUR and ureteral stenosis, with one case leading to ureteral rupture. Early complications were often detected due to acute graft dysfunction, while late ones were mainly identified during routine clinical, laboratory, or ultrasound follow-up. Urological complications requiring surgical or endoscopic therapy were 13.4%. Most ureteral stenoses were treated with initial endoscopic stents, followed by definitive surgery. VUR was treated with endoscopic correction with a high success rate (75%), while open surgery was reserved for cases where initial treatments failed or complications recurred. No clear correlations were found between patient characteristics and risk of urological complication. Urological complications required multiple diagnostic procedures and therapeutic interventions (+2.5 admissions in mean and approximately +EUR 24,000) compared to an uncomplicated post-transplant course. However, they did not significantly impact transplant outcomes, with a graft survival rate comparable to that of the control group. Conclusions: Regular post-transplant follow-up is crucial, especially for patients with known risk factors, to allow for timely detection and treatment of urological complications, avoiding detrimental effects on graft function and improving transplantation outcomes.

INJURY OF THE DISTAL URETER SECONDARY TO NORMAL VAGINAL DELIVERY: A COMPREHENSIVE REVIEW

Spontaneous ureteric rupture after a normal vaginal delivery is a rare occurrence, with about five cases reported in literature. We reviewed the literature with the aim to evaluate the causes of such an injury, presenting signs and symptoms, diagnosis, management strategies, outcome and follow up. Recognition and timely repair are critical to prevent long term complications and ensure good quality of life for the women suffering such a trauma. Clinicians must consider spontaneous ureteral rupture in the differential diagnosis for postpartum abdominal pain and flank pain when common causes have been ruled out. Diagnosis can be made with contrast-enhanced Computed Tomography scan and cystoscopy. In majority of cases, ureteral stenting or endoscopic repair are reasonable options for management.

Second case of spontaneous left ureter rupture during normal spontaneous vaginal delivery

Second case of spontaneous left ureter rupture during normal spontaneous vaginal delivery

Investigation of a Mass Stranding Event Reveals a Novel Pattern of Cascading Comorbidities in Northern Fulmars (Fulmarus glacialis).

During 2018, a seabird mortality event occurred in central California, US, that affected Northern Fulmars (Fulmarus glacialis), Common Murres (Uria aalge), and Cassin's Auklets (Ptychoramphus aleuticus). An increase in beachcast birds were reported on standardized surveys in conjunction with an increased number of live-stranded birds admitted to rehabilitation centers. Neurologic symptoms were noted during intake examination for some birds. Coincident with the mortality event, increased levels of the harmful algal bloom toxins domoic acid and saxitoxin were recorded in Monterey Bay and Morro Bay. Birds that died in care and beachcast carcasses were submitted to the California Department of Fish and Wildlife-Marine Wildlife Veterinary Care and Research Center for postmortem examination (n=24). All examined birds were emaciated. Examined Common Murres and Cassin's Auklets had no gross evidence of preexisting disease; however, all examined Northern Fulmars exhibited severe pyogranulomatous inflammation of the urogenital system at gross postmortem exam. Tissues from nine Northern Fulmars were examined by histopathology, and samples from two Northern Fulmars were tested for the presence of domoic acid and saxitoxin. Histopathology revealed moderate to severe kidney infection by Eimeria sp. and gram-negative bacteria, intratubular urate stasis, ureter rupture, and emaciation. Additionally, domoic acid and saxitoxin were detected simultaneously in tissues of some tested birds. This communication highlights a novel pattern of cascading comorbidities in native seabirds from a mass stranding event.

Laparoscopic ureteral reimplantation with a Boari flap for long-segment ureteric avulsion or ureteric strictures: our experience.

This study was designed to evaluate the feasibility of laparoscopic ureteral reimplantation with a Boari flap for long-segment ureteric avulsion or ureteric strictures of the middle and lower ureters. By observing its curative effect and prognosis, we can provide a safer and reliable treatment option for patients with middle and lower ureteral injury. In this study, of the eight cases under study, five were diagnosed with long-segment ureteric strictures, one had long-segment ureteric avulsion, one was diagnosed with ureteral rupture caused by surgical injury of appendicitis, and the remaining one underwent ureterostomy after ureteralinjury. The location of ureteral injury was in the middle lower segment. All eight patients underwent laparoscopic ureteral reimplantation with a Boari flap from January 2018 to October 2021. In this study, two patients were treated with a Boari bladder flap with psoas hitching. All procedures were performed by the same surgeon with over 20years of experience in urological surgery. The mean length of ureteric avulsion or ureteric strictures was 7.94cm (range, 4-15cm). Laparoscopic ureteral reimplantation with a Boari flap was performed successfully between 120 and 240min. The mean duration of postoperative hospital stay was 6days, and no major complications related to the procedure in the perioperative period occurred. Postoperative follow-up showed no obvious hydronephrosis on computed tomography urography or urinary ultrasound in all eight patients. Postoperative reexamination did not reveal any significant hydronephrosis, urinary tract infection, or ureteral reflux, and none of the postoperative renal functions were abnormal. Laparoscopic ureteral reimplantation with a Boari flap is safe and feasible for experienced physicians. In our case, the length/width ratio of bladder flap is more than 4:1, with good blood supply and no obvious complications, it provides a longer alternative length.

Analysis of long-term effect of ureteral balloon dilatation combined with internal and external drainage tube in the treatment of benign ureteral stricture

PurposeThere are few reports about balloon dilatation combined with internal and external drainage tube in the treatment of ureteral stricture under interventional therapy. The aim of the study is to explore the safety, effectiveness and long-term efficacy of this treatment strategy.Materials and methodsIt is a retrospective and observational study. From October 2013 to October 2016, 42 patients with benign lower ureteral stricture received interventional treatment. Balloon dilatation combined with internal and external drainage tube implantation were used. There were 25 male patients and 17 female patients. There were 7 cases (16.7%) with congenital ureteral stricture, 12 cases (28.6%) with inflammation, 15 cases (35.7%) with ureteral stricture after lithotomy or lithotripsy, and 8 cases (19.0%) with ureteral stricture after pelvic or abdominal surgery. After the drainage tube was removed, B ultrasound, enhanced CTU or IVP of urinary system were reexamined every six months. The follow-up time was 12–60 months.ResultsThe age was 52.9 ± 11.6 years. The length of ureteral stricture was 1.1 ± 0.5 cm. 42 patients completed interventional treatment, the technical success rate was 100%, no ureteral perforation, rupture or other complications were identified. Preoperative urea nitrogen 9.2 ± 2.3 mmol/L and creatinine 175.8 ± 82.8umol/L. Urea nitrogen and creatinine were 3.8–9.1 mmol/L and 45.2–189.6 umol/L when removing the drainage tube. There were significant differences in the levels of urea nitrogen and creatinine before and after tube removal (P < 0.05). The ureteral patency rate was 100% at 6 months, 93% at 12 months, 83% at 18 months, 79% at 24 months, 76% at 30 months and 73% at 36–60 months. The overall success rate was 73%. Multivariate Cox regression analysis showed that stenosis length was a risk factor for postoperative patency (P < 0.05).ConclusionBalloon dilatation combined with internal and external drainage tube implantation in the treatment of benign lower ureteral stricture is safe and effective.

Ureteric Rupture: Rare Complication of Inappropriate Urinary Bladder Catheterization

AbstractWe have reported case of 71-year-old male with acute urinary retention due to gross prostatomegaly. Due to inappropriate catheterization, urinary bladder remained distended and ultimately caused left ureteric rupture. This article is peculiar as it shows that misplaced Foley's catheter may also lead to exceedingly rare complication of ureteric rupture and highlights importance of proper management of difficult catheterization which is otherwise considered a simple procedure.

ACUTE RESPIRATORY DISTRESS: A RARE PRESENTATION OF URETERAL RUPTURE

TOPIC: Signs and Symptoms of Chest Diseases TYPE: Medical Student/Resident Case Reports INTRODUCTION: Cardiorespiratory disorders usually present with acute respiratory distress; likewise, ureteral rupture usually presents as an acute abdomen [1]. We report a case of ureteral rupture presenting with acute respiratory distress leading to a delayed diagnosis. CASE PRESENTATION: An 82 y/o M with a history of congestive heart failure (CHF), chronic obstructive pulmonary disease, chronic renal failure and recently diagnosed COVID -19 pneumonia, was admitted for progressive dyspnea and abdominal discomfort for 2 days. Arterial blood gas showed hypercapnic hypoxic respiratory failure. Chest computed tomographic (CT) scan without contrast showed moderate right-sided pleural effusion but pulmonary embolism (PE) could not be ruled out. He also had a left leg deep venous thrombosis with worsening renal function and B-type natriuretic peptide (BNP) of 139pg/ml.His symptoms were thought to be due to acute decompensated CHF, COVID-19 pneumonia and possible PE. He failed to improve with intravenous furosemide, bilevel positive airway pressure ventilation and empiric anticoagulation. Due to worsening renal function and abdominal pain, an abdominal CT was done which showed right ureteral rupture with retroperitoneal collection and multiple non-obstructing renal calculi. The patient had placement of a double J stent with prompt resolution of respiratory distress. DISCUSSION: There are very few case reports of ureteral rupture occurring spontaneously and causing marked dyspnea. Respiratory distress may occur if the extravasated urine leads to an urinothorax or abdominal compartment syndrome [1]. Suspicion of non-cardiorespiratory causes of acute dyspnea in patients with underlying congestive heart failure includes respiratory distress disproportionate to the size of pleural effusion, unilateral effusions or effusions of markedly disparate size, absence of pulmonary vascular congestion and cardiomegaly, worsening renal function, ascites, urinary retention or anuria, abdominal pain, failure of the effusion to respond to management of heart failure, fever or pleuritic chest pain, and low or near-normal natriuretic peptides [2,3].When there are concerns for non-cardiorespiratory causes of respiratory distress, the diagnosis can be made with thoracentesis and imaging such as abdominal ultrasound, or CT [2]. CONCLUSIONS: This case illustrates a rare presentation of ureteral rupture causing respiratory distress and the key points that should elicit high clinical suspicion for non-cardiorespiratory causes of acute respiratory distress. When these findings are present, appropriate investigations and urgent intervention may be life-saving. REFERENCE #1: Choi SK, Lee S, Kim S, et al. A rare case of upper ureter rupture: ureteral perforation caused by urinary retention. Korean J Urol. 2012;53(2):131-133. doi:10.4111/kju.2012.53.2.131 REFERENCE #2: Leonidas Laskaridis, Spyridon Kampantais, Chrysovalantis Toutziaris, Basileios Chachopoulos, Ioannis Perdikis, Anastasios Tahmatzopoulos, Georgios Dimitriadis, "Urinothorax—An Underdiagnosed Cause of Acute Dyspnea: Report of a Bilateral and of an Ipsilateral Urinothorax Case", Case Reports in Emergency Medicine, vol. 2012, Article ID 395653, 3 pages, 2012. https://doi.org/10.1155/2012/395653 REFERENCE #3: Porcel JM. Pleural effusions from congestive heart failure. Semin Respir Crit Care Med. 2010 Dec;31(6):689-97. DOI: 10.1055/s-0030-1269828. Epub 2011 Jan 6. PMID: 21213200. DISCLOSURES: No relevant relationships by sharmela Brijmohan, source=Web Response No relevant relationships by Angelica Medina-Pena, source=Web Response No relevant relationships by Noura Semreen, source=Web Response

Spontaneous Ureteric Rupture and Its Implications in the Emergency Department: A Case Report.

IntroductionSpontaneous ureteric rupture is uncommon and has a wide range of presentations. Accurate diagnosis and timely treatment is necessary to avoid potential serious complications.Case ReportWe present the case of a 55-year-old female who presented with severe right lower abdominal pain with rebound tenderness, vomiting, and a single episode of hematuria. A computed tomography with intravenous contrast of the abdomen and pelvis showed a 0.3-centimeter right upper ureteric calculus, with hydronephrosis and ureteric rupture. In view of the scan findings, a diagnosis of spontaneous ureteric rupture secondary to urolithiasis was made. The patient underwent a percutaneous nephrostomy and ureteric stenting.ConclusionSpontaneous rupture of the ureter is an uncommon diagnosis for which clinical and laboratory signs may not always be reliably present. A high index of suspicion is required for diagnosis, which is usually confirmed on advanced imaging. It may occur in serious complications of urinoma and abscess formation. As such, accurate diagnosis and timely treatment is crucial.

Spontaneous ureteral rupture after extracorporeal shock wave lithotripsy: a case with review of literature

Spontaneous ureteral rupture after extracorporeal shock wave lithotripsy: a case with review of literature

In vitro study of age-related changes in human ureteral failure properties according to region, direction, and layer.

Knowledge of the capacity of the ureteral wall to withstand urodynamic or external stresses is essential to understand ureteral injury and rupture that mostly occur following trauma, but may also be secondary to obstructive uropathy. It has clinical significance as well in the prevention of iatrogenic injury, for example, during ureteroscopy, but no information is available with regard to the age-related failure properties and regional differences have not been systematically described. Uniaxial tensile testing was performed on 166 ureteral rings and strips from 21 humans free of overt urologic disease; histological evaluation was performed. The degree of layer participation to the intact wall failure stress (=tissue strength), peak elastic modulus (=stiffness), and failure stretch (=extensibility) was assessed by examining layer-specific ruptures in the stress-stretch data. Failure stress at and peak elastic modulus before the first (muscle/adventitial) rupture correlated inversely less with age ( p < 0.05 in few regions/directions) than failure stress at the second (mucosal) rupture ( p < 0.05 in the middle and lower ureter), consistent with the decreased mucosal thickness in ≥50-year-old subjects. Failure stretch at both ruptures did not correlate with age ( p > 0.05 in most regions/directions), paralleling elastin content. Correlations with age were more significant in females than males. Failure stress at the second rupture point was higher ( p < 0.05) distally in <50-year-old but not in ≥50-year-old subjects, justified by the increased collagen distally in the former. Directional differences in failure stretches ( p < 0.05 at all ages/regions/genders) were justified by preferentially axial collagen reinforcement. The presented results may establish the foundation for computational models of iatrogenic/accidental ureteral trauma.

Emergency laparoscopic exploration of postpartum spontaneous rupture of the urinary bladder:A case report and review of literature

Introduction: Spontaneous rupture of the urinary bladder(SRUB) is a relatively rare cause of acute abdomen disease, whcih was easily complicated with diffuse peritonitis, septic shock, acute renal failure. Athough a few cases about postpartum patient sufferred from SRUB have been reported recently,the management of postpartum SRUB was not well established. Case Report: The subject of this case was a 37-year-old postpartum woman who presented with abdominal pain for one day.Based on his clinical presentation, investigation results, it was highly suspected for urinary disease complicated with diffuse peritonitis, such as SRUB, ureteral rupture. Given that vital signs were unstable and peritonitis signs were aggravating gradually, emergency laparoscopic exploration were performed. There was a visible rupture in the left posterior of the bladder wall, with a diameter of 2cm.Laparoscopic repair was employed and patient recovered well. In this article, we also reviewed relevant literatures to initially establish main diagnostic basis for postpartum SRUB. Conlcusion: Postpartum women with a complaint of acute abdomen pain maybe caused by SRUB, especially companied with oliguria and dysuria. And laparoscopy have an obvious advantage to the diagnosis and treatment for highly suspected postpartum SRUB.

Spontaneous Ureteral Rupture Secondary to Obstructing Stone

Rupture of the urinary collecting system with or without perinephric extravasation is a rare occurrence and usually known to occur following an obstructive pathology.[1,2] Here we present a case of distal 6mm calculus in otherwise normal kidney in elderly male, presenting secondary to ureteropelvic junction rupture.

Spontaneous ureteral rupture caused by iliac aneurysm: a case report

BackgroundRupture of the ureter with extravasation resulting from an iliac aneurysm is extremely rare. Herein, we report a case of ureteric rupture with urinary extravasation secondary to an iliac aneurysm.Case presentationAn 80-year-old man was admitted to our hospital for sudden onset of severe abdominal pain. Contrast-enhanced computed tomography demonstrated a large left internal iliac aneurysm (6.5 cm in diameter) and a ureteric rupture with leakage of contrast media from the left ureter, indicating a spontaneous ureteral rupture. The patient was treated with placement of a ureteral double-J stent under endoscopic and X-ray fluoroscopic guidance and endovascular aortic repair. His postoperative course was uneventful and he was discharged on postoperative day 20. A computed tomography scan at 2 weeks after surgery showed no contrast extravasation from the ureter or end leak.ConclusionCombination treatment with ureteral and endovascular stenting is effective in avoiding aneurysmal rupture and the serious consequences of a ureteral rupture, which include a perinephric or retroperitoneal collection, abscess formation, subsequent urosepsis, and graft infection.

Rare cas de perforation urétérale compliquant le vissage pédiculaire par chirurgie minimale invasive

Introduction Injury of the ureter is a potentially devastating complication most often reported in gynecologic, colorectal, and vascular pelvic operations or endoscopic procedures for ureteric pathologies. Our objectives are to present a literature review and meta-analysis of ureteral injury during posterior spine operation, and to describe a rare case of ureteral rupture occurring as a complication of percutaneous pedicle screw placement. Material and methods PubMed and EMBASE were screened for studies of ureteral injury caused by posterior lumbar operation. Studies in any other language than English were excluded. A case illustration is presented. Clinical Presentation: A 60-year-old man complained of unbearable abdominal pain on the day after right L4-L5 transforaminal intervertebral fusion and percutaneous pedicle screw placement. The computer tomography scan revealed contrast media extravasation outside the excretory system consistent with a left ureteral traumatic perforation. He underwent left nephrostomy and double-J stent insertion, and subsequently fully recovered. The ureter completely healed, enabling stent removal 5 months later. Results Of 118 references, we found 27 reports of ureteral injury caused by posterior lumbar operation, with only one other case following minimally invasive transforaminal lumbar interbody fusion (MI-TLIF). Complications of minimally invasive pedicle screw placement are often described as a dural tear or neurologic impairment. A meta-analysis of the literature found 27 patients with ureteral injury as a complication of spine operation. Our reported case is the first described after MI-TLIF. Conclusion This report shows that unexpected side effects of MI-TLIF are still possible, and spine surgeons should be aware of this, especially while performing minimally invasive procedures, in which by definition, the pedicles are concealed for direct visualization.

Surgical correction of ureter rupture due to stenosis induced secondary to accidental injury by placing nephrovesical subcutaneous ureteric bypass in a dog

Objective: The aim of this paper is to report surgical correction of ureteric rupture due to stenosis induced secondary to accidental injury by placing nephrovesical subcutaneous ureteric bypass in a dog and postoperative long term outcomes. Materials and methods: Imaging techniques revealed multiple bone fractures as well as left proximal ureter injury. The all bone fractures were corrected using standard techniques while left proximal ureter injury was treated as conservation medical therapy. One month later, contrast media were also found in proximal ureter and abdomen which indicated ureter rupture. This rupture was corrected surgically by nephrovesical subcutaneous ureteric bypass (SUB) under fluoroscopy guidance. Results: First day after accidental injury, the serum BUN and CRE were 10.7 mg/dL and 0.9 mg/dL, respectively which indicated kidney injury but by conservative therapy these parameters were lowered gradually. On the 5 th day after considering these parameters, the dog was judged normal. However, on the 31 st day BUN and CRE were 14.3 mg/dL and 0.8 mg/Kg, respectively. The Doppler ultrasonography revealed hydroneprosis, proximal ureter stenosis and high resistive index (0.72±0.02) in the renal arcuate artery indicating renal abnormalities due to ureter obstruction. On re-examination by radiography after one month postoperatively, revealed that patency of the device and normal renal function. The dog was clinically normal with normal urination and no complications were found 6 months postoperatively. Conclusion: In view of the above findings, it is suggested that the SUB system can be a better alternative to preserve the kidney in non-reparable traumatic ureteral damage in dogs. http://doi.org/10.5455/javar.2018.e266

A Case of Upper Ureter Rupture With Acute Kidney Injury.

We herein report a case of ureter rupture with severe oliguric acute renal injury due to benign prostatic hypertrophy. After insertion of an indwelling urinary catheter, the patient’s urine output immediately increased. His symptoms and renal function also rapidly improved to the normal range without a surgical operation. Clinicians should note this complication in patients with oliguria.

Questions of terminology, systematization and grading of complications of contact ureteral lithotripsy

To investigate the advantages and disadvantages of the current variants of systematization and grading of complications of contact ureteral lithotripsy (CULT) and develop a working classification of CULT complications. The study analyzed results of 545 fluoroscopy-guided endoscopic procedures performed at the MRRCI Clinic of Urology from 2008 to 2015 in 506 patients with ureterolithiasis. The proposed and implemented classification and terminology of CULT complications unifies the diagnostic and management algorithm. This tool is more systematic and structured than the classical classification and universal methods of systematization and grading of CULT complications (classifying CULT complications in "major" and "minor", PULS scale, Satava and Clavien-Dindo grading systems). Given the lack of clear grading of ureteral rupture, it was divided into amputation (two-level rupture) and avulsion (one-level rupture). Using such term as extravasation of the contrast media and/or migration of the stone outside of the ureter is groundless because these complications occur only after the perforation of the ureteral wall. Therefore, these conditions are complications not of CULT, but of the ureteral wall perforation. The ureteral perforation was classified into macro- and micro-perforation. The existing terminology, classification and grading of the CULT complications should undergo a more detailed analysis. None of the existing classifications of CULT complications afford them to be fully staged and systematized. The working classification of complications of CULT developed at the M.F. Vladimirsky MRRCI Clinic of Urology warrants a multi-center prospective study to validate it and investigate its effectiveness.

Spontaneous proximal ureteric rupture secondary to ureterolithiasis

We present the case of a 37-year-old lady who presented with severe colicky left sided flank pain associated with vomiting, chills and rigors. A non-contrast Computed Tomography of the Kidney Ureter and Bladder was performed which showed a 2–3 mm stone in the pelvic part of the left ureter. Following 2 days of conservative treatment she was still complaining of increasingly severe pain. A contrast computed tomography of the abdomen was performed which was suggestive of a perforation of the left collecting system. A diagnosis of spontaneous left proximal ureteric perforation secondary to urolithiasis was made. We opted to treat her with retrograde endoscopic ureteric stent insertion. Spontaneous rupture of the ureter is a relatively rare urological occurrence with only a small number of cases reported in the literature. Although there are no recommendations, ureteric double-J stenting is the most commonly used management option with good results reported.

Spontaneous ureteral rupture

Summary Spontaneous ureteral rupture is defined as the nontraumatic leakage of urine from the ureter. This is a rare urological disorder, and only a small number of cases have been reported. Here, we report a rare case of a patient with spontaneous ureteral rupture who presented at our emergency department with abdominal distension and flank pain; the final diagnosis was confirmed through computed tomography (CT). The patient received urgent right percutaneous nephrostomy, double-J stenting, and treatment with broad-spectrum antibiotics, which resulted in a favorable outcome. Although uncommon, emergency physicians must have knowledge regarding this condition, which often presents as an acute abdominal condition and may be misdiagnosed as another condition requiring surgical intervention. Abdominal ultrasonography and CT should be included in the treatment of all cases suspected with this condition in order to reduce unnecessary surgical intervention.