Spontaneous forniceal rupture: Can it be treated conservatively?

Affiliations

03 January 2017

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doi: 10.4103/0974-7796.198883


Abstract

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.

Keywords: Forniceal; rupture; stone.

Conflict of interest statement

There are no conflicts of interest.


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KMEL References


References

  1.  
    1. Robertson WG. Stone formation in the Middle Eastern Gulf States: A review. Arab J Urol. 2012;10:265–72. - PMC - PubMed
  2.  
    1. Gershman B, Kulkarni N, Sahani DV, Eisner BH. Causes of renal forniceal rupture. BJU Int. 2011;108:1909–11. - PubMed
  3.  
    1. Miller OF, Kane CJ. Time to stone passage for observed ureteral calculi: A guide for patient education. J Urol. 1999;162(3 Pt 1):688–90. - PubMed
  4.  
    1. Porpiglia F, Ghignone G, Fiori C, Fontana D, Scarpa RM. Nifedipine versus tamsulosin for the management of lower ureteral stones. J Urol. 2004;172:568–71. - PubMed
  5.  
    1. Agrawal M, Gupta M, Gupta A, Agrawal A, Sarkari A, Lavania P. Prospective randomized trial comparing efficacy of alfuzosin and tamsulosin in management of lower ureteral stones. Urology. 2009;73:706–9. - PubMed
  6.  
    1. Doehn C, Fiola L, Peter M, Jocham D. Outcome analysis of fornix ruptures in 162 consecutive patients. J Endourol. 2010;24:1869–73. - PubMed
  7.  
    1. Autorino R, De Sio M, Damiano R, Di Lorenzo G, Perdonà S, Russo A, et al. The use of tamsulosin in the medical treatment of ureteral calculi: Where do we stand? Urol Res. 2005;33:460–4. - PubMed
  8.  
    1. Apoku IN, Ayoola OO, Salako AA, Idowu BM. Ultrasound evaluation of obstructive uropathy and its hemodynamic responses in southwest Nigeria. Int Braz J Urol. 2015;41:556–61. - PMC - PubMed
  9.  
    1. Upputalla R, Moore RM, Jim B. Spontaneous forniceal rupture in pregnancy. Case Rep Nephrol 2015. 2015:379061. - PMC - PubMed
  10.  
    1. Coelho RF, Schneider-Monteiro ED, Mesquita JL, Mazzucchi E, Marmo Lucon A, Srougi M. Renal and perinephric abscesses: Analysis of 65 consecutive cases. World J Surg. 2007;31:431–6. - PubMed
  11.  
    1. Kalafatis P, Zougkas K, Petas A. Primary ureteroscopic treatment for obstructive ureteral stone-causing fornix rupture. Int J Urol. 2004;11:1058–64. - PubMed