Spontaneous Rupture of the Upper Urinary Tract Caused by Ureteral Calculi: Effectiveness of Primary Ureteroscopic Treatment

Managing renal forniceal rupture secondary to ureteric calculi in line with the NICE 2019 Renal and Ureteric Stone Guidelines

“…Obstruction in the distal ureter, including the vesicoureteric junction (VUJ) is responsible 54.9–87.5% of presentations. 4–8 ,13,14,18 The causes of RFR in adults are summarised in Table 1 and urolithiasis related RFR by stone location is presented in Table 2.…”

“…Patients with RFR secondary to urolithiasis are commonly cited as having a high risk of developing renal and perinephric abscesses, prompting clinicians to treat all patients (92–100%) with prophylactic antibiotics, while positive urine cultures are reported in the range 15–34.9%. 4,6–8,13,14,18 There are certainly historical cases of RFR due to ureteric obstruction causing perirenal abscesses and groups have reported 10.5–16.9% of these abscesses are attributable to ureteric obstruction (with causes including ureterolithiasis). 19–21 However, the converse association is less significant – only one perirenal abscess was reported in 476 patients across the seven case series of RFR published in the last two decades, occurring after intervention and discussed below.…”

“…4,6–8,13,14,18 There are certainly historical cases of RFR due to ureteric obstruction causing perirenal abscesses and groups have reported 10.5–16.9% of these abscesses are attributable to ureteric obstruction (with causes including ureterolithiasis). 19–21 However, the converse association is less significant – only one perirenal abscess was reported in 476 patients across the seven case series of RFR published in the last two decades, occurring after intervention and discussed below. 4,6–8,13,14,18 This low incidence of abscess formation could be attributable to concomitant antibiotic treatment, indiscriminately used prophylactically in most cases.…”

“…19–21 However, the converse association is less significant – only one perirenal abscess was reported in 476 patients across the seven case series of RFR published in the last two decades, occurring after intervention and discussed below. 4,6–8,13,14,18 This low incidence of abscess formation could be attributable to concomitant antibiotic treatment, indiscriminately used prophylactically in most cases. It is worth noting the EAU’s guidelines for urological trauma, which recommend avoiding the routine use of antibiotic prophylaxis for urinary extravasation.…”

“…It is worth noting the EAU’s guidelines for urological trauma, which recommend avoiding the routine use of antibiotic prophylaxis for urinary extravasation. 4,6,8,11,13,14…”