Spontaneous perforation of the ureter: clinical presentation and endourologic management

BACKGROUND AND PURPOSE: Spontaneous perforation of the upper ureter is a rare condition that poses diagnostic and therapeutic problems. We report on five cases from three institutions and discuss the literature. PATIENTS AND METHODS: Five patients presented with renal colic and the imaging modalities used to assess them showed extravasation of urine. RESULTS: The cause of spontaneous perforation of the ureter was a ureteral stone in one case and was unknown in four cases. In all cases, a Double-J ureteral stent was inserted under fluoroscopy. Urinoma was percutaneously drained in only one patient. Repeat imaging showed normal renal function and morphology in all patients. CONCLUSION: Spontaneous perforation of the ureter should be suspected after renal colic. Endourologic treatment offers excellent results, even for the management of acute complications.