Renal calyceal rupture in pregnancy: A systematic review

Abstract

Objective Spontaneous rupture of the renal fornix is a rare event. To date, there is limited information available to both the urologist and obstetrician regarding calyceal rupture in pregnancy. Diagnosis may be confused with the multitude of other pregnancy related, and, non pregnancy related causes of abdominal pain. Outcomes for these patients, both urologic and obstetric, are currently unknown. Our aim is to analyse presentations of these patients and to better understand the short and long term effects of renal system rupture on pregnancy and renal function. Methods A systematic review of literature databases (Pubmed, Embase, Cochrane Library, SCOPUS and Web of Science) was performed using the Preferred Reporting Items for Systematic Reviews and Mata-Analyses (PRISMA) guidelines. Inclusion criteria included any urinary extravasation from they kidney or ureter during pregnancy, or in the 8 weeks following, confirmed via imaging or surgery. Haematomas and unconfirmed cases were excluded. Results From a total of 1175 screened records, 35 case reports were included in final analysis. Rupture most commonly occurs during the 1st pregnancy (80%) and in the 3rd trimester (51%). All patients presented with pain, with right sided rupture most commonly found (65%). Bilateral rupture was found in 5% of cases. Secondary symptoms were most commonly nausea and/or vomiting (34%), fever (14%) and lower urinary tract symptoms (11%). Pregnancy related factors were most commonly associated with rupture (uncomplicated pregnancy 27/35 cases, 1/35 of breech presentation, caesarean section complication and preeclampsia). Ultrasound scanning was the most common 1st line investigation, with diagnosis made in the first instance in 42% of cases. Ureteric stents were used in 40% of cases, with nephrostomy (23%), ureteral catherization (14%), percutaneous drainage (14%) and conservative treatment (14%) used respectively. We identified a mean gestation of delivery at 35 completed weeks with 29% of infants delivered preterm at <37 weeks. Importantly, the only significant long term urologic complication described was nephrectomy performed as a 1st line treatment, before the routine availability of ureteric stents. Conclusion Renal collecting system rupture is a rare complication of pregnancy. Although there appears to be no significant long term effect on patients renal system following this event, the same cannot be said for the pregnancy and fetus. Preterm delivery is well known to be negatively associated with fetal outcomes, and therefore knowledge of the potential side effects of calyceal rupture may allow early or improved interventions from both urologist and obstetrician.L6215696842018-04-11 <br />