INJURY OF THE DISTAL URETER SECONDARY TO NORMAL VAGINAL DELIVERY: A COMPREHENSIVE REVIEW

Spontaneous ureteric rupture after a normal vaginal delivery is a rare occurrence, with about five cases reported in literature. We reviewed the literature with the aim to evaluate the causes of such an injury, presenting signs and symptoms, diagnosis, management strategies, outcome and follow up. Recognition and timely repair are critical to prevent long term complications and ensure good quality of life for the women suffering such a trauma. Clinicians must consider spontaneous ureteral rupture in the differential diagnosis for postpartum abdominal pain and flank pain when common causes have been ruled out. Diagnosis can be made with contrast-enhanced Computed Tomography scan and cystoscopy. In majority of cases, ureteral stenting or endoscopic repair are reasonable options for management.