Spontaneous Ureteral Rupture During a ^99mTc-Mercaptoacetyltriglycine Renal Scan

DISCUSSION

Nontraumatic spontaneous ureteral rupture is a rare urologic emergency. Although no definite cause has been identified in this particular case (1), a few risk factors are noted, such as an obstructing calculus, a ureteral stricture, malignancy, and prior surgery (2). Our patient had a medical history of prior prostate cancer and prior ureteral surgery which increased his risk for nontraumatic spontaneous ureteral rupture. We hypothesize that the culminating factor leading to this adverse event was the Foley catheter malfunction during the renal scan. The ordering services and urology department requested Foley catheter placement before the study to ensure bladder emptying. Yet, traumatic placement of the Foley catheter led to clot formation and iatrogenic bladder outlet obstruction. As the renal scan progressed, images demonstrated rapid accumulation of urine with radiotracer into the bladder, an unexpected finding in a patient with a patent Foley catheter. Within minutes, this led to progressive distension of the right renal pelvis and right renal rupture.

Although commonly performed, transurethral catheterization can be a hazardous procedure leading to acute urinary retention in elder men (3). Early signs of Foley catheter malfunction manifest as decreased urine output, abdominal pain, a change in urine color, and urine leakage from the insertion site (4). A nuclear technologist can also detect Foley catheter malfunction on the images, when urine accumulates in the bladder or refluxes back into the pelvis. Early intervention on catheter obstruction is crucial in preventing adverse outcomes such as infections, bladder rupture, ureteral rupture, or, rarely, death (5).