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* 109/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 tubes were 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.

Keywords

ESWL, spontaneous ureteral rupture, double-j stent, ureteral stones, frequent urination, painful urination, hematuria, fever, dysuria, urinoma, kidney damage, sepsis