Renal Forniceal Rupture in the Setting of Obstructing Ureteral Stones: An Analysis of Stone Characterization and Urologic Intervention Pattern.

Forniceal rupture due to obstructing ureterolithiasis (FROU) is a seldom encountered radiographic finding, but the impact of this diagnosis and influence on stone management has not been well studied in the literature. The purpose of the study is to examine stone characteristics and intervention patterns of patients with radiographic evidence of FROU. A retrospective analysis of all patients with radiographic evidence of FROU was compared with patients with obstructing ureteral stones without forniceal ruptures (noFROU). All patients presented to our Emergency Department from January 2015 until December 2018. Data analyzed included patient demographics, clinical presentation, stone characteristics, and management pattern. Primary outcome was need for hospital admission and surgical intervention. Thirty-two patients with FROU (mean age = 45) were compared with 50 patients with noFROU (mean age = 57). Univariate analysis revealed that age, history of diabetes mellitus, history of hypertension, days of symptoms, degree of hydronephrosis, and degree of perinephric stranding were associated with forniceal rupture ( ≤ 0.05). On multivariate analysis, only degree of perinephric stranding remained significant ( ≤ 0.05). Average maximum axial stone diameter in the FROU group was 5.1 mm 4.7 mm in the noFROU group ( = 0.66). Overall, 68.8% of stones were located within the distal ureter in the FROU group 48.8% in the noFROU group ( = 0.09). There was no difference in hospital admission (FROU 37.5% noFROU 44%,  = 0.56) and need for surgical intervention (FROU 50% noFROU 48%,  = 0.86). There were no 30-day complications in patients with FROU. Ureteral stone location and size does not seem to impact the presence of FROU. FROU may be an alarming reported finding but its presence does not appear to impact clinical outcomes or affect urological management, including admission or need for urologic intervention.