Spinelli Matteo Giulio, Palmisano Franco, Zanetti Stefano Paolo, Boeri Luca, Gadda Franco, Talso Michele, Dell'Orto Paolo Guido, Montanari Emanuele
Department of Urology. IRCCS Ca' Granda Ospedale Maggiore Policlinico. University of Milan. Milan. Italy.
Arch Esp Urol. 2019 Jul;72(6):590-595.
To evaluate incidence, clinical, radiological and laboratory features of spontaneous upper urinary tract rupture (s-UUTR) due to ureteric stones and discuss their management.
Out of 1629 patients admitted to the Emergency Department (ED) for renal colic from January 2015 to December 2016 and studied by kidney US and contrast enhanced CT (CECT), 31 patients had a s-UUTR categorized in 3 stages: a) local spread, b) free fluid, c) urinoma. Presentation, therapeutic procedures and outcomes were registered.
S-UUTR is reported in 1.9% of renal colic. The stone was most commonly identified at the vesicoureteric junction (VUJ) (61.3%) and mean (standard deviation, SD) stone size was 5.71 mm (2.31). S-UUTR was most frequently located in a calyx (54.84%). 26 patients (83.87%) had a clinical presentation of a renal colic, 3 cases (9.68%) had an atypical presentation and 2 (6.45%) presented an acute abdomen. In 26 cases a J-J stent (83,87%) was placed, 3 patients underwent primary ureteroscopic lithotripsy (9.67%); in 1 patient (3.23%) a nephrostomy was inserted and in 1 case (3.23%) active surveillance was adopted. Cases who underwent sole urinary derivation were revaluated after 30 days: ureteroscopic lithotripsy was performed in 48.15% of the cases; extracorporeal shock wave lithotripsy in 3.7%; in 22.2% of cases a CT demonstrated the spontaneous expulsion of the stone. 7 patients were lost at follow-up. The patient undergoing an active surveillance spontaneously expelled the stone.
S-UUTR is a rare radiological sign of a renal colic most commonly located in a calyceal fornix. A high incidence of s-UUTR is caused by small distal ureteral stones in which a spontaneous passage is reasonable. Clinical presentation usually does not arise the suspicion of s-UUTR. In our experience, most patients were actively treated with good results but a conservative approach can be offered in selected cases.
评估输尿管结石所致自发性上尿路破裂（s-UUTR）的发病率、临床、影像学和实验室特征，并探讨其治疗方法。
在2015年1月至2016年12月因肾绞痛入住急诊科（ED）并接受肾脏超声和增强CT（CECT）检查的1629例患者中，31例发生s-UUTR，分为3个阶段：a）局部扩散，b）游离液，c）尿囊肿。记录患者的临床表现、治疗过程及结果。
s-UUTR在肾绞痛患者中的发生率为1.9%。结石最常见于膀胱输尿管连接处（VUJ）（61.3%），平均（标准差，SD）结石大小为5.71 mm（2.31）。s-UUTR最常位于肾盏（54.84%）。26例（83.87%）患者临床表现为肾绞痛，3例（9.68%）表现不典型，2例（6.45%）表现为急腹症。26例患者置入了J-J支架（83.87%），3例患者接受了一期输尿管镜碎石术（9.67%）；1例患者（3.23%）插入了肾造瘘管，1例患者（3.23%）采取了主动监测。仅接受尿液引流的患者在30天后进行复查：48.15%的病例进行了输尿管镜碎石术；3.7%进行了体外冲击波碎石术；22.2%的病例CT显示结石自行排出。7例患者失访。接受主动监测的患者结石自行排出。
s-UUTR是肾绞痛罕见的影像学表现，最常位于肾盏穹窿部。s-UUTR的高发生率是由输尿管远端小结石引起的，结石自行排出是合理的。临床表现通常不会引起对s-UUTR的怀疑。根据我们的经验，大多数患者接受积极治疗效果良好，但在某些特定情况下可采取保守治疗方法。
