Outcome analysis of fornix ruptures in 162 consecutive patients.

BACKGROUND: Fornix rupture is a potential urologic emergency. In most cases, ureteral stones represent the underlying cause. Management of a fornix rupture is not standardized. PATIENTS AND METHODS: In a retrospective analysis, we investigated 162 patients who had received a diagnosis of fornix rupture between 1994 and 2005. In all patients, the diagnosis was based on radiographic investigations with application of contrast media. We evaluated the parameters' underlying cause, associated symptoms, diagnostic and therapeutic procedures, and outcome in patients with a fornix rupture. RESULTS: There were 121 men and 41 women with a median age of 53 years (range 20-79 years). In 93.2% of patients, one or more symptoms were present at diagnosis. In 59.9% of cases, a ureteral stone was diagnosed; in 12.3%, the underlying cause was different; and in the remaining 27.8% of patients, no reason for a fornix rupture was found. In all patients, primary endoscopic therapy (96.3%) or insertion of a nephrostomy tube (3.7%) was performed. All patients had a bladder catheter inserted, and antibiotic treatment was given in 92% of patients. A renal or perirenal abscess or other secondary complications necessitating open operative revision did not develop in any patient. The retrospective manner is a limitation of our study. Comparison of subgroups may therefore be biased. CONCLUSIONS: Ureteral stones are the most frequent causes of a fornix rupture. With a low pressure system and antibiotic treatment, the outcome is excellent, and secondary complications can be effectively prevented. Parameters for conservative treatment are to be defined to reduce overtreatment of certain patients with a fornix rupture.

Mesonephroid adenocarcinoma arising from mesonephroid metaplasia of the urinary bladder.

We present a rare case of mesonephroid adenocarcinoma arising from mesonephroid metaplasia of the urinary bladder. For the first time, the unique histopathologic features in this patient provide evidence for the theory that vesical mesonephroid adenocarcinoma might be a highly aggressive metaplastic variant of urothelial carcinoma that should be treated accordingly.