A Case of Upper Ureter Rupture With Acute Kidney Injury
Published in Clinical Medicine Insights: Case Reports, the authors present a case of ureter rupture with severe oliguric acute renal injury due to benign prostatic hypertrophy. Clinicians should note this complication in patients with oliguria.

A 76-year-old man without renal impairment was admitted to the emergency department due to oliguria and back pain.

Blood tests showed severe renal dysfunction (creatinine, 19.6 mg/dL; blood urea nitrogen, 148 mg/dL) and hyperkalemia (8.3 mEq/L). He had no external trauma and no history of ureteric instrumentation during the previous 3 weeks or surgery on the kidneys or upper ureters. Computed tomography revealed urinary extravasation in the left perinephric space (Figure 1A, arrow) with bilateral hydronephrosis (Figures 1A, 2), marked bladder dilation with urine, and benign prostatic hypertrophy (Figure 2, arrow).

No external compression or stones were detected in the bilateral kidneys and ureters. No pelvic tumor or lymphadenopathy was present. These findings led to a diagnosis of left ureter rupture with oliguric acute renal injury due to benign prostatic hypertrophy. The patient underwent insertion of an indwelling urinary catheter and administration of intravenous antibiotics.

His urine output immediately increased after urinary catheter insertion. His symptoms and renal function also rapidly improved to the normal range. Follow-up computed tomography after 2 weeks revealed improvement of urinary extravasation and bilateral hydronephrosis (Figure 1B). There are several debates regarding a surgical procedure versus nonsurgical supportive treatment as the initial treatment for ureter rupture.

In this case, both the ureter rupture and hydronephrosis were improved with nonsurgical treatment. Further studies are required to investigate the optimal treatment for ureter rupture.

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