Perinephric urinoma following spontaneous renal rupture in the third trimester of pregnancy: a case report and brief review of the literature

Background: Spontaneous 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. Methods: A 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. Results: A 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 postnatal 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. Conclusion: While 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.

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“…5). Only one patient requested, and was granted, pre-term delivery at 35 weeks secondary to pain from SRFR [19].…”

Section: Outcomes and Complicationsmentioning

confidence: 99%

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

McKnoulty

Green

Scott³

et al. 2020

BMC Urol

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“…10 Although right-sided rupture is more common, there have been case reports of women with spontaneous renal system rupture during pregnancy on the left side without underlying renal conditions as well. 2,12,14,15,21,25,31,35,37,39,40,43,44,51,52 Kim et al 50 reported a case of spontaneous, bilateral renal pelvis rupture after a cesarean delivery, and we add the second case of bilateral spontaneous renal rupture to the literature.…”

Section: Pathophysiologymentioning

confidence: 97%

Spontaneous Renal Rupture During Pregnancy: A Contemporary Literature Review and Guide to Management

Cardenas

Doiron²,

Ramseyer

et al. 2021

Obstetrical &Amp; Gynecological Survey

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Importance: Spontaneous renal rupture is a rare pregnancy complication, which requires a high index of suspicion for a timely diagnosis to prevent a poor maternal or fetal outcome.Objective: This review highlights risk factors, pathophysiology, symptoms, diagnosis, management, and complications of spontaneous renal rupture in pregnancy.Evidence Acquisition: A literature search was carried out by research librarians using the PubMed and Web of Science search engines at 2 universities. Fifty cases of spontaneous renal rupture in pregnancy were identified and are the basis of this review.Results: The first case of spontaneous renal rupture in pregnancy was reported in 1947. Rupture occurs more commonly on the right side and during the third trimester. Pain was a reported symptom in every case reviewed. Treatment usually consists of stent or nephrostomy tube placement. Conservative management has been reported.Conclusions: When diagnosed early and managed appropriately, maternal and fetal outcomes are favorable. Preterm delivery is the most common complication.Relevance: Our aim is to increase the awareness of spontaneous renal rupture in pregnancy and its associated complications in order to improve an accurate diagnosis and maternal and fetal outcomes.Target Audience: Obstetricians and gynecologists, family physicians Learning Objectives: After completing this activity, the learner should be better able to identify the risk factors of spontaneous renal rupture in pregnancy; outline the presenting signs and symptoms of renal system rupture during pregnancy; explain the preferred diagnostic tools and imaging modalities for diagnosing renal system rupture in pregnancy, including the risks and benefits to the fetus; and describe the management and potential complications of pregnant patients presenting with renal system rupture.Renal rupture is a rare complication of pregnancy with a limited number of cases reported in the medical literature. [1][2][3] Spontaneous renal rupture is diagnosed when rupture occurs without recent surgery or trauma. 2,4 The concept of spontaneous renal rupture in the general population was introduced by Wunderlich in 1856, and the first case of urinary tract rupture during pregnancy was reported by Campbell 5 in 1947. 1,4 Because of the limited amount of information in the literature, it may be difficult to determine the diagnosis and appropriate management plan from both a urologic and obstetrical standpoint.All authors, faculty, and staff in a position to control the content of this CME activity have disclosed that they have no financial relationships with, or financial interests in, any commercial organizations relevant to this educational activity. Disclaimer: J.A.P. is an active duty member of the Armed Forces. The views expressed are those of the author(s) and do not reflect the official policy of the Department of the Army, Department of Defense, or the US Government. The investigators have adhered to the policies for protection of human subjects as prescribed in 45 CFR 46.

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“…The treatment methods for renal rupture are varied. [1][2][3] The spontaneous renal rupture has been reported in many literature before, but it caused by hemophilia has hardly been reported. The report describes a rare case of left renal rupture caused by hemophilia, furthermore, the patient also had some atrophy of the right kidney.…”

Section: Introductionmentioning

confidence: 99%

Spontaneous renal rupture caused by factor VII deficiency: A case report

Yang,

Luo,

et al. 2024

Medicine

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Rationale: Spontaneous renal rupture is an uncommon disease, it usually occurs after upper urinary calculi-related operation treatment or renal tumor. This disease caused by factor VII deficiency has rarely reported. Patient concerns: A 49-year-old woman came to our hospital with on the left flank pain and gross hematuria that had persisted for 10 days. The patient had no recent history of waist and abdominal trauma or surgical history recently. Diagnoses: An outside computed tomography (CT) examination revealed left renal rupture before arriving at our hospital, but she was not treated. Further laboratory examination revealed that the patient condition was turned out to be hemophilia caused by factor VII deficiency. Intervention: We have used both internal and external drainage methods, and supplemented with coagulation factor. Outcome: After 9 months of follow-up, it was observed that the left renal hematoma and urinary extravasation was completely absorbed. Lessons: Spontaneous renal rupture for hemophilia is a clinical emergency. When spontaneous renal rupture is associated with abnormal coagulation function, and the coagulation function cannot be corrected by conventional treatment, the possibility of hemophilia needs to be considered, and the type of hemophilia needs to be further defined. This case indicates a successful resolution of spontaneous renal rupture, it can provide guiding value for our clinical practice.

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Perinephric urinoma following spontaneous renal rupture in the third trimester of pregnancy: a case report and brief review of the literature

Cited by 9 publications

References 29 publications

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

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

Spontaneous Renal Rupture During Pregnancy: A Contemporary Literature Review and Guide to Management

Spontaneous renal rupture caused by factor VII deficiency: A case report

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