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

Abstract

Objective: To study the diagnosis and treatment of spontaneous ureteral rupture after extracorporeal shock wave lithotripsy (ESWL).Methods: A case of spontaneous ureteral rupture after ESWL was analyzed retrospectively. A 30-year-old male presented to the emergency clinic with severe and progressive right flank pain for the last 24 hours. He did not complain of frequent urination, painful urination, hematuria, fever, dysuria. He underwent ESWL of right renal stone 4 days ago. Physical examination showed tenderness in the right abdomen and percussion pain in the right renal area. His leukocyte count and neutrophils and lymphocytes were 22.36* 10 9 /L, 92.0%, 6.3%, respectively; blood urea nitrogen and blood creatinine were 9.0 mmol/L, 166 umol/L respectively. His ultrasound was suggestive of right hydronephrosis and right distal ureteral stones and a small perinephric fluid. No improvement, treated by a medical expulsive therapy for 2 days. CTU (Computed Tomography Urography) showed the right upper ureteral rupture and right hydronephrosis and right lower ureteral stones. Holmium laser lithotripsy under ureteroscope was performed under general anesthesia and double J stent was inserted. Results:The operation was a success. His routine blood and serum creatinine returned to normal 6 days later. Another day later, CTU showed less right hydronephrosis than before and no perinephric fluid and no ureteral stones. His catheter was removed 10 days later and was discharged without any complications. The double-J stent was removed 6 weeks later. Conclusion:Spontaneous ureteral rupture after ESWL is a rare entity. It can cause serious complications, including urinoma, kidney damage, sepsis. A careful clinical and ultrasound or CTU monitoring with a high index of suspicion of it is necessary after each ESWL therapy. The prompt treatment of the condition will achieve good results.