Brihh Journal of Urology (1979). 51. 51

Spontaneous Rupture of the Ureter during High Dose Urography operation was carried out to evacuate the encysted urine and drain the retroperitoneal area. In 7 days the ureter had healed and the patient left hospital in good health.

Cpse Report A 30-yeardd woman, who had had a stone removed from the upper third of her left ureter 5 years ago and who had developed a stone in her left renal pelvis 3 years ago, was admitted with high fever and a painful swelling in the left lumbar region. Emergency high dose urography without abdominal compression revealed extravasation from the left ureter at the level of the third lumbar vertebra but no stone (Fig.). A few days later she passed a large stone and 4 days thereafter again developed high fever. As urography at this time revealed persistent and increased extravasation,

Comment Non-traumatic extravasation of urine is uncommon and usually occurs in chronically diseased or obstructed kidneys. More unusual is spontaneous rupture of the ureter, but with increased use of emergency high dose urography in the investigation of renal colic it has been reported frequently in recent years (Kettlewell et al., 1973; Ramsey et af., 1973). If the urinary tract is acutely obstructed, the increase in intraluminal pressure, augmented by a sudden diuretic load of urographic contrast medium, may rupture it at the weakest point. In a healthy tract the weakest point is at the caliceal fornices, but extravasation at this level is usually of little importance. Rupture of the upper third of the ureter, as in our case, is unusual. We think that the ureterotomy ,S years previously had made the upper third of the left ureter thin and inelastic. References Kettlewell,

M.,

Walker,

M.. Dudley, N.

and de Souza,

B.

(1973). Spontaneous extravasation of urine secondary to ureteric obstruction. British Journal of Urology, 45, 8-14. Ramsey. E. W.. Janylo. S. V. and Bruce. A. W. (1973). Spontaneous extravasation of urine from the renal pelvis and ureter. Journal of Urology, 110, 507-512.

The Authors T. Becopoulos. M. Likourinas and G. Pliotas, Department of Urology, King Paul’s Hospital, Athens, Greece.

Fig.

51

Spontaneous rupture of the ureter during high dose urography.

Brihh Journal of Urology (1979). 51. 51 Spontaneous Rupture of the Ureter during High Dose Urography operation was carried out to evacuate the encyst...
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