Morgan Tara Nikonow, Bandari Jathin, Shahait Mohammed, Averch Timothy
Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, PA.
Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, PA.
Urology. 2017 Nov;109:51-54. doi: 10.1016/j.urology.2017.07.045. Epub 2017 Aug 8.
To outline treatment considerations and outcomes for a cohort of patients with forniceal rupture with the aim of adding to a very limited body of literature regarding clinical practice in this area.
We retrospectively searched all radiographic records for patients treated at our institution between January 2009 and January 2016 with forniceal rupture. We compiled demographic data, etiology, clinical factors, treatments, and outcomes.
Of the 103 patients analyzed, the median age at presentation was 64 years (interquartile range 52-73), and 56 (54%) were female. The etiology of forniceal rupture was most commonly urolithiasis (73%), with cancer being the next most common cause (11%). Most cases (61%) were caused by small (1-5 mm) stones in the distal ureter. Thirty-one patients (30%) were treated surgically with ureteral stent placement upfront; 27 of those patients had a ureteral stone, and most had some clinical factors making them higher risk. There was only 1 operative complication during the study period. Only 1 patient developed an abscess. Forty-three patients (42%) were sent home from the emergency room. Of the patients who were admitted, the average hospital stay was 3 days (interquartile range 2-6). For the entire cohort, there were 6 (6%) readmissions in the study period.
Very limited data exist in the literature regarding clinical practice in the treatment of forniceal rupture. Clinical practice at our institution is conservative treatment of forniceal rupture in the absence of infection, kidney failure, or other risk factors with few complications or readmissions.
概述一组穹窿破裂患者的治疗考量及结果，旨在补充该领域临床实践方面极为有限的文献资料。
我们回顾性检索了2009年1月至2016年1月期间在我院接受治疗的穹窿破裂患者的所有影像学记录。我们汇总了人口统计学数据、病因、临床因素、治疗方法及结果。
在分析的103例患者中，就诊时的中位年龄为64岁（四分位间距为52 - 73岁），56例（54%）为女性。穹窿破裂的病因最常见的是尿路结石（73%），其次是癌症（11%）。大多数病例（61%）是由输尿管远端的小结石（1 - 5毫米）引起的。31例患者（30%）首先接受了输尿管支架置入术；其中27例患者有输尿管结石，且大多数患者有一些使其风险较高的临床因素。研究期间仅发生1例手术并发症。仅1例患者出现脓肿。43例患者（42%）从急诊室出院。在入院的患者中，平均住院时间为3天（四分位间距为2 - 6天）。对于整个队列，研究期间有6例（6%）再次入院。
关于穹窿破裂治疗的临床实践，文献中的数据非常有限。我院的临床实践是在无感染、肾衰竭或其他风险因素的情况下，对穹窿破裂进行保守治疗，并发症及再次入院情况较少。
