Spontaneous renal pelvis rupture: a case report

Abstract

Spontaneous renal pelvic rupture (SRPR) is a rare entity. Diagnosis is made by contrast-enhanced computed tomography or retrograde pyelography, and management may be active or conservative. We present the case of a 79-year-old woman who developed SRPR of the left kidney on the fifth postoperative day of a right laparoscopic nephroureterectomy with endoscopic bladder cuff resection. Active management was decided and a ureteral catheter was placed. Symptoms improved and the patient did not develop any complications during follow-up. This case report explores SRPR, a condition with traumatic and non-traumatic causes, including urethral calculi and congenital abnormalities. SRPR is the result of a sudden increase in intraluminal pressure, often exceeding 20–75 mmHg, causing tissue tearing at the weakest urinary tract point, the fornix. In this instance, the patient experienced contralateral renal pelvic rupture following nephroureterectomy with no apparent cause for elevated intrarenal pressure. We propose that bladder irritation after ureteral cuff resection induced spasms, triggering the rupture. Diagnostic challenges arise as initial symptoms mimic renal colic, later manifesting as a urinoma. Imaging techniques, such as ultrasonography and contrast-enhanced CT, aid in the diagnosis. Treatment options encompass ureteral stenting and conservative management, with the choice depending on the patient’s condition. This case underscores the significance of early recognition and management of SRPR, especially following nephroureterectomy. In conclusion, SRPR is an entity that requires immediate management. It is important to evaluate if there are any features that require active treatment.

Keywords: Spontaneous renal pelvic rupture, laparoscopic nephroureterectomy, urinoma, active management, renal function impairment