Urol Res (2007) 35:215–218 DOI 10.1007/s00240-007-0101-9 123 CASE REPORT Perforation of the upper ureter: a rare complication of extracorporeal shock wave lithotripsy Mehmet Turgut · Cavit Can · Aydin Yenilmez · Nevbahar Akcar Received: 2 April 2007 / Accepted: 7 May 2007 / Published online: 31 May 2007  Springer-Verlag 2007 Abstract Perforation of the upper ureter is a rare but seri- ous complication of extracorporeal shock wave lithotripsy (SWL). Ureteral perforation can cause a series of problems including the retroperitoneal urinoma, urosepsis, abscess formation, infection, and subsequent renal function impair- ment. We reported here a rare case of SWL-induced upper ureteral rupture resulting in an expanding retroperitoneal urinoma that required percutaneous drainage. Ureteral per- foration was treated successfully without major surgical intervention by employing temporary percutaneous drain- age and antibiotics. The present case indicates that potential ureter rupture may form in rare cases; especially in patients having infected stones and exposed to a high number of shock waves. This complication further emphasizes the importance of adequate pre-and post-operative evaluation and the precise identiWcation of the cause of the persistent pain after SWL. Keywords Extracorporeal shock wave lithotripsy · Complication · Urinary stone · Ureter perforation Introduction Extracorporeal shock wave lithotripsy (SWL) has become the preferred treatment modality for many urologists because of its eVective, practical and noninvasive nature for the majority of the stones located in the upper urinary tract. The features of the stone, such as size, location, nature, number, and urinary system anatomy, deWne the indications for SWL. Complications of this procedure are related to the administration of shock waves, which may aVect adjacent organs as well as the urinary system, and to the fragmented particles which may cause ureteral colic and ureteral obstruction. The incidence of the major complications after SWL is less than 1% and they include subcapsular and peri- renal hematoma, ureterovaginal and ureterocolic Wstula, ruptured renal pelvis and spleen, acute pancreatitis and pul- monary complications [1–7]. In addition to these complica- tions, to our knowledge retroperitoneal urinoma resulting from the perforation of upper ureter during or following SWL treatment has not been reported in the English litera- ture. Therefore, this might be the Wrst reported case. Case report A 32-year-old female patient was admitted to our clinic with severe discomfort in the right upper abdomen. She also had fever, nausea and anorexia. The patient’s history revealed an SWL procedure performed 2 weeks earlier for a right proximal ureteral stone (7 £ 5 mm). The stone was diagnosed by the presence of a radio-opacity in the upper ureter trajectory using plain kidney-ureter-bladder (KUB) Wlm and this was further veriWed by ultrasonography. The stone was present in the upper ureter and a mild to moder- ate hydroureteronephrosis was seen proximal to it on USG. During the procedure a total of 4,500 shock waves, 80 shocks per min, at 21 kV (for each wave) in one session were applied using an electrohydraulic lithotripter (PCK, Ankara, Turkey). M. Turgut (&) · C. Can · A. Yenilmez Department of Urology, Eskisehir Osmangazi University, Eskisehir, Turkey e-mail: mturgut@ogu.edu.tr N. Akcar Department of Radiology, Eskisehir Osmangazi University, Eskisehir, Turkey