Korean J Urol.  2012 Feb;53(2):131-133.

A Rare Case of Upper Ureter Rupture: Ureteral Perforation Caused by Urinary Retention

• Choi SK
• Lee S
• Kim S
• Kim TG
• Yoo KH
• Min GE
• Lee HL

Abstract

Perforation of the ureter is a rare condition that causes a series of problems including retroperitoneal urinoma, urosepsis, abscess formation, infection, and subsequent renal impairment. There are causative factors that induce ureteric rupture, including malignancy, urinary calculi, idiopathic retroperitoneal fibrosis, recent iatrogenic manipulation, external trauma, degenerative kidney conditions, urography with external compression, and spontaneous causes. We report a rare case of ureteric rupture caused by urinary retention. The patient was treated with temporary percutaneous drainage and antibiotics. The present case illustrates that urinary retention can induce not only bladder rupture, but also ureteric rupture. It is thus of paramount importance to effectively manage patients with voiding problems.

Keyword

Neurogenic bladder, neurogenic; Rupture; Ureter; Urinary retention

MeSH Terms

Abscess
Anti-Bacterial Agents
Drainage
Humans
Kidney
Retroperitoneal Fibrosis
Rupture
Ureter
Urinary Bladder
Urinary Calculi
Urinary Retention
Urinoma
Urography
Anti-Bacterial Agents

Figure

• 

  FIG. 1 (A) CT image showing a dilated bladder, suggestive of urinary retention. (B) CT image showing extravasation of radiocontrast from the ruptured ureter. Contrast medium leakage into the perirenal space is shown. CT, computed tomographic.

• 

  FIG. 2 Antegrade pyelography showing no leakage of contrast medium after 7 days.

Reference

1. Kaplan LM, Farrer JH, Lupu AN. Spontaneous rupture of ureter. Urology. 1987. 29:313–316.

2. Titton RL, Gervais DA, Hahn PF, Harisinghani MG, Arellano RS, Mueller PR. Urine leaks and urinomas: diagnosis and imaging-guided intervention. Radiographics. 2003. 23:1133–1147.

3. Diamond DA, Marshall FF. The diagnosis and management of spontaneous rupture of the ureter. J Urol. 1982. 128:808–810.

4. Katz R, Meretyk S, Gimmon Z. Abdominal compartment syndrome due to delayed identification of a ureteric perforation following abdomino-perineal resection for rectal carcinoma. Int J Urol. 1997. 4:615–617.

5. Stravodimos K, Adamakis I, Koutalellis G, Koritsiadis G, Grigoriou I, Screpetis K, et al. Spontaneous perforation of the ureter: clinical presentation and endourologic management. J Endourol. 2008. 22:479–484.

6. Chapman JP, Gonzales J, Diokno AC. Significance of urinary extravasation during renal colic. Urology. 1987. 30:541–545.

7. El-Boghdadly SA. Spontaneous rupture of the ureter proximal to ureteric stone. J R Soc Med. 1985. 78:255–257.

8. Davies P, Bates CP, Price HM. Chronic peripelvic extravasation treated conservatively. Br J Urol. 1981. 53:412–415.

9. Kettlewell M, Walker M, Dudley N, De Souza B. Spontaneous extravasation of urine secondary to ureteric obstruction. Br J Urol. 1973. 45:8–14.