Spontaneous forniceal rupture: Can it be treated conservatively?

Spontaneous forniceal rupture is one of the possible complications of urolithiasis. The mechanism of forniceal rupture is not well explained in the literature. Most of the cases presented with sudden onset of acute renal colic and diagnosed by noncontrast CT (NCCT). Until now there is no solid consensus about the ideal management of such a condition.

To study indications and validity of conservative management of spontaneous caliceal rupture.

This is an observational prospective study.

All cases diagnosed as spontaneous forniceal rupture in our departments from 2011 to 2015 were enrolled. All cases were diagnosed with NCCT or CT-Urography.. Non complicated patients were primarily managed conservatively. Intervention (DJ stent insertion, nephrostomy tube insertion, or urgent ureteroscopy) was reserved to complicated cases or solitary kidney. Drainage of urinoma was done in cases with sizable urinoma (more than 100 ml³).

A total of 40 patients: Twenty eight (70%) patients had normal serum creatinine level at presentation, while 12 (30%) patients had elevated serum creatinine. Twenty three (57.5%) patients were successfully managed conservatively, their mean size of stone was 6.2 ± 2 mm and the hospital stay was 3.1 ± 1.9 days. Eighteen patients (42.5%) underwent interventions. Their stone size was 4.5 ± 2.1 mm and the hospital stay for the interventional group was 4.2 ± 1.8 days.

Mann-Whitney test was used for testing difference between means because the data groups are not parametric. Otherwise, simple descriptive statestics were used.

Spontaneous forniceal rupture is more likely to occur with smaller distal ureteric stones. Conservative management is a valid option in non-complicated cases. Intervention should be reserved to complicated cases or cases with sizable urinoma.