A 63-year-old man presented with hydronephrosis due to a malfunctioned ureteral stent. During placement of a nephrostomy catheter to relieve the obstruction, the proximal ureter was perforated. The ureteral rupture was treated successfully with progressively larger nephrostomy catheters and antibiotics without need for emergency surgery. The case illustrates that during nephrostomy catheter placement in obstructed patients, pointing the catheter tip towards the ureteral wall can cause perforation, and advancing the guidewire distally in the renal pelvis may reduce this risk.

1. IATROGENİC URETERAL RUPTURE:
URETERAL PERFORATION CAUSED BY
NEPHROSTOMY CATHETER
Ali DADASHOV,
Bulent KARAMAN,Aydın ASLAN

2. • Perforation of the ureter during nephrostomy
catheter placement is a rare condition that
may cause a series of problems including
retroperiteonal urinoma, urosepsis, abscess
formation, infection etc.
• We report a rare case of ureteric rupture
caused by nephrostomy catheter.

3. • The patient was managed with progressively
enlarged nephrostomy catheters with
continuation of percutaneous drainage and
antibiotics.
• The present case illustrates that wrong
drection of nephrostomy chatheter in patients
with ureteral obstruction for any reason can
perforate ureter, which in turn may be treated
by continuation of percutaneous drainage
avoiding an emergency surgery.

4. • During nephrostomy catheter placement,
ureteral rupture may occur if you point
chatheter tip to the wall of the obstructed
ureter.
• We report a case of ureteral rupture in a
patient who had a malfunctioned ureteral
stent and bladder tumor.

5. • A 63-year-old man was admitted to our
department with hydronephrosis due to
malfunctioned ureteral stent (double-j
chatheter).
CASE RAPORT

6. CASE RAPORT
• His medical history revealed a bladder tumor
with ureteral invasion. After intraducing a
amplatz guidewire to renal pelvis it was sent
to bladder in paralel to the stent.

7. CASE RAPORT
• After the percutaneous tract dilatation
nephrostomy chatheter was sent over the
guide wire.
• Distal part of catheter was left in the proximal
ureter and guide wire was removed.

8. CASE RAPORT
• Pig tail formation of the distal chatheter part was
achivied. After wards, contrast material was injected
and extravasation from proximal ureter was seen to
demonstrate rupture of proximal ureter.

9. CASE REPORT
• One day later patient was called for control and
contrast enhanced radiogram was obtained.
Extravasation was persistent and for this reason 8F
catheter was repliced with 10 F catheter and
antibiotherapy was started.
BEFORE AFTER

10. CASE REPORT
• Three days later the patient was called back
for control.

11. CASE REPORT
• Diminshing extravasation was seen in the
control pyelography. This time catheter was
replaced with 14 F size.
THE FIRST DAY 3 DAYS LATER

12. CASE REPORT
• After a few days patient was called for another
control. Spontaneous ureteral healing were
verified.
THE FIRST DAY
3 DAYS LATER
8 DAYS LATER

13. CASE REPORT
• Spontaneous ureteral healing and working
ureteral stents were verified.

14. RESULT
• Eventually ureteral stent obstruction was
decided to have developed secondary to
infection in the first place,which was then
relivied following anti-infection treatment.
İncluding antibiotics and continuors
percutanouse drainage.

15. RESULT
• When a nephrostomy catheter placement is
planned in a patient who has hydronephrosis
for any reason, advancing the guide wire into
the renal pelvis as distally as possible instead
of placing it in the ureter will likely reduce the
risk of ureteral rupture that may be caused by
nephrostomy.