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Phimosis of the Prepuce of the Clitoris: Indication for Female Circumcision

rupture of the ureter the contrast material should not appear around calyces, which is usually the case with forniceal rupture (Ginsberg 1965). Further, the patient is usually much more unwell, with a high temperature and leukocytosis. It is not uncommon to confuse this condition with other acute abdominal emergencies. Retroperitoneal sepsis is a common complication, and 3 deaths have been reported (Berry 1921, Geisinger 1931) in association with rupture of the ureter due to retroperitoneal sepsis. The treatment of choice is open drainage of the retroperitoneal space with an attempt to remove the stone if found. Should a stone be found in the lower ureter with a tear proximal to it, either in the ureter or renal pelvis, endoscopic extraction of this stone with the Dormia basket is sufficient, without the need for open drainage. The latter treatment was successful in our patient and has not been described previously. Antibiotic cover is mandatory. The cause of rupture of the ureter could be explained on the basis of either stone impaction causing pressure necrosis or, as the stone is passing in the ureter, it may traumatize the ureter; in either case, when the intraureteric pressure increases during an attack on renal colic, the damaged tissue may give way. This case presented several additional interesting features. The stone was found to be distal to the site of the leak. The ureter proximal to the stone was not dilated, a feature noted in 2 cases reported by Weaver (1980). It may be that the escape of urine through the renal vent allows the intraureteric pressure to remain unchanged, with no proximal dilatation of the ureter.