• Guang-Heng Chen, Po-Jen Hsiao, Yi-Huei Chang, Chi-Cheng Chen, Hsi-Chin Wu, Chi-Rei Yang, Kuo-Liang Chen, Eric Chieh-Lung Chou, Wen-Chi Chen, and Chao-Hsiang Chang.
• Department of Urology, China Medical University Hospital, Taichung, Taiwan.
• Am J Emerg Med. 2014 Jul 1;32(7):772-4.

IntroductionSpontaneous ureteral rupture is defined as non-traumatic urinary leakage from the ureter. This is a diagnosis that, although uncommon, is important for emergency physicians to know about. The literature is relatively sparse.Materials And MethodsThis was a retrospective review of patients who were diagnosed with spontaneous ureteral rupture. From 2006 to 2012, 18 patients were diagnosed by radiography (computed tomography or intravenous urogram) with spontaneous ureteral rupture. These cases all showed extravasation of the contrast outside the excretory system. We evaluated underlying causes, diagnostic and therapeutic procedures, and outcomes.ResultsThere were 9 men and 9 women with a median age of 59 years (range, 22-82 years). In 56% of patients, a ureteral stone was the cause; in 17% of, a ureteral stricture; in 1 patient, a ureteral tumor; and in the remaining 22%, no cause was identified. In 13 patients (72.2%), primary ureteroscopy to place D-J stents was performed. The average duration of ureteral catheter stenting was 21 days (range, 8-45 days). The other 5 patients (27.8%) were managed conservatively with antibiotic treatment and the outcome was good.ConclusionsUreteral stones most commonly cause spontaneous ureteral rupture. In our experience, most patients received ureteroscopy and Double-J stenting. Conservative management with antibiotics also had good outcomes. Most patients had sudden onset of abdominal or flank pain. Spontaneous ureteral rupture should be kept in the differential diagnosis of patients with acute abdominal or flank pain in the emergency department.Copyright © 2014 Elsevier Inc. All rights reserved.

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