Department of Urology, Massachusetts General Hospital, Harvard Medical School, Boston, 02114, USA.
BJU Int. 2011 Dec;108(11):1909-11; discussion 1912. doi: 10.1111/j.1464-410X.2011.10164.x. Epub 2011 Jul 8.
What's known on the subject? and What does the study add? Renal forniceal rupture is a common finding in patients with ureteral obstruction. It is thought to be due to increased renal pelvis pressure from backup of urine, causing one or more renal fornices to leak urine. This phenomenon has not been systematically studied. Herein we retrospectively review the causes and associated clinical findings in over 100 cases of renal forniceal rupture.
• To perform a retrospective review aiming to identify causes of renal forniceal rupture.
• A retrospective review was performed of the longitudinal medical record and CT records for patients identified as having renal 'forniceal rupture' or 'calyceal rupture' using a radiological database.
• In total, 108 patients were identified with the CT diagnosis of renal 'forniceal' or 'calyceal' rupture. • Forniceal rupture was caused by ureteric stones in 80 cases (74.1%), malignant extrinsic ureteric compression in nine cases (8.3%), benign extrinsic ureteric compression in two cases (1.9%), pelvic-ureteric junction obstruction in two cases (1.9%), vesico-ureteric junction (VUJ) obstruction in one case (0.9%), bladder outlet obstruction in one case (0.9%) and iatrogenic causes in four cases (3.7%). • No definitive cause was found in nine cases (8.3%). For patients in whom a ureteric stone was the cause of forniceal rupture, the level of obstruction was proximal ureter in 24.3% of cases, distal ureter in 17.6% of cases and VUJ in 58.1% of cases. • Mean (sd) stone size was 4.09 (2.0) mm. Mean (sd) stone size was 5.34 (1.87) mm for proximal stones, 4.08 (1.69) mm for distal stones and 3.53 (1.96) mm for VUJ stones (P= 0.005). • Urinary tract infection was present in five out of 97 patients (5.2%) in whom data were available for analysis.
• The most common aetiology of renal forniceal rupture is obstruction caused by distal ureteric stones followed by malignant extrinsic ureteric compression.
• 旨在确定肾穹窿破裂的原因。
• 对使用放射学数据库确定的具有肾“穹窿”或“肾盂”破裂的患者的纵向病历和 CT 记录进行回顾性分析。
• 共发现 108 例 CT 诊断为肾“穹窿”或“肾盂”破裂的患者。• 80 例（74.1%）由输尿管结石引起的穹窿破裂，9 例（8.3%）由恶性输尿管外压引起，2 例（1.9%）由良性输尿管外压引起，2 例（1.9%）由肾盂输尿管交界处梗阻引起，1 例（0.9%）由膀胱输尿管连接部梗阻引起，1 例（0.9%）由膀胱出口梗阻引起，4 例（3.7%）由医源性原因引起。• 在 9 例（8.3%）中未发现明确病因。对于因输尿管结石导致穹窿破裂的患者，梗阻部位位于上段输尿管的占 24.3%，下段输尿管的占 17.6%，膀胱输尿管连接部的占 58.1%。• 结石大小的平均值（标准差）为 4.09（2.0）mm。上段结石的平均（标准差）结石大小为 5.34（1.87）mm，下段结石为 4.08（1.69）mm，膀胱输尿管连接部结石为 3.53（1.96）mm（P=0.005）。• 在可分析数据的 97 例患者中有 5 例（5.2%）存在尿路感染。
• 肾穹窿破裂最常见的病因是由下段输尿管结石引起的梗阻，其次是恶性输尿管外压。
