Minimally invasive treatment of urinary fistulas using N-butyl-2-cyanoacrylate: a valid first line option

Abstract

BackgroundA few single case reports and only one clinical series have been published so far about the use of N-butyl-2-cyanoacrylate in the treatment of urinary fistulas persisting after conventional urinary drainage.Case presentationWe treated five patients with a mean age of 59.2 years presenting iatrogenic urinary fistulas which persisted following conventional drainage manouvres. There were 3 calyceal fistulas following open, laparoscopic and robotic removal of renal lesions respectively, one pelvic fistula after orthotopic ileal neobladder and a bilateral dehiscence of uretero-sigmoidostomy. We used open-end catheters of different sizes adopting a retrograde endoscopic approach for cyanoacrylate injection in the renal calyces, while a descending percutaneous approach via the pelvic drain tract and bilateral nephrostomies respectively was used for the pelvic fistulas. Fluoroscopic control was always used during the occlusion procedures. The amount of adhesive injected ranged between 2 and 5 cc and in one case the procedure was repeated. With a median follow-up of 11 months we observed clinical and radiological resolution in 4 cases (80%), while a recurrent and infected calyceal fistula after laparoscopic thermal renal damage during tumor enucleoresection required nephrectomy. No significant complications were documented.ConclusionsIn an attempt to spare further challenging surgery in patients that had been already operated on recently, minimally invasive occlusion of persistent urinary fistulas with N-butyl-2-cyanoacrylate represents a valid first line treatment, justified in cases when the urinary output is not excessive and there is a favorable ratio between the length and diameter of the fistulous tract.

A systematic review on the use of topical hemostats in trauma and emergency surgery

“…More recently, in addition to these fields of use, the application of cyanoacrylate glues has been reported for the management of urinary fistula. Selli et al [ 43 ] described a case series of five patients suffering from iatrogenic urinary fistulas, which were successfully managed by a minimally invasive injection of N-butyl-cyanoacrylate, seemingly a valid first line treatment, justified in cases when the urinary output is not excessive and there is a favorable ratio between the length and diameter of the fistulous tract.…”

Polycyanoacrylate (super glue) as bladder concretion in a patient after bilateral inguinal hernioplasty

“…Some recent studies demonstrated cyanoacrylate bladder stone formation following occlusion of vesicosigmoid fistula. 16,17 Moreover, we did not detect any polypropylene (mesh) as part of the investigated concretion. The possible mechanism of the stone formation in the presented case could be explained by the fact that during the cyanoacrylate application, instillation of the cyanoacrylate into the bladder through the bladder wall on the left side led to the formation of the concretion.…”

Renal artery embolization in the treatment of urinary fistula after renal duplication: A case report and review of literature

“…The incidence rate is less than 10% in the literature[ 29 ]. In previous reports, there have been many successful cases of using fibrin glue, coils, or NBCA glue for percutaneous obliteration of urinary fistula[ 30 - 37 ]. However, the operation can be cumbersome sometimes, and multiple uses of materials could also lead to excessive hospitalization costs.…”