Percutaneous Ureteral Clipping: Long-term Results and Complications

Farrell, Tony; Yamaguchi, Toshio; Barnhart, William; Lang, E K

doi:10.1016/s1051-0443(97)70588-8

Cited by 7 publications

(9 citation statements)

References 13 publications

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“…They obtained complete ureteral occlusion and cessation of leakage in four patients. In 1997, Farrell et al (38) reported on their experience (14 ureters in eight patients) with ureteral clipping. All patients reported substantial clinical improvement, and perineal dryness was obtained in all but one patient.…”

Section: Direct Ureteral Approachesmentioning

confidence: 99%

Fistulas of the Lower Urinary Tract: Percutaneous Approaches for the Management of a Difficult Clinical Entity

Avritscher¹,

Madoff²,

Ramírez³

et al. 2004

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Fistulas of the lower urinary tract are uncommon conditions that may occur spontaneously or after therapy in patients with various pelvic abnormalities. When present, these fistulas are associated with urine leakage, which is often socially distressing and disabling. Unfortunately, factors that lead to the formation of genitourinary fistulas often increase their complexity or preclude surgical repair. A high failure rate is associated with surgical repair, and many patients are not optimal surgical candidates. For such patients, a percutaneous treatment approach is highly desirable. Percutaneous ureteral occlusion combined with insertion of a functioning nephrostomy tube allows complete diversion of urine in those patients in whom nephrostomy alone does not provide adequate relief. Many approaches to percutaneous ureteral occlusion have been used with variable success, including coils and gelatin sponge, isobutyl-2-cyanoacrylate, detachable balloons, radiofrequency electrocautery, ureteral clipping, and solid and soft polymer agents. Furthermore, percutaneous or retrograde ureteral stents may be used to preserve antegrade urine flow, and surgical options are also available. It is essential that the interventional radiologist involved in the care of these patients be familiar with these different techniques as well as with the limitations, pitfalls, and possible complications of their use.

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Section: Direct Ureteral Approachesmentioning

confidence: 99%

Fistulas of the Lower Urinary Tract: Percutaneous Approaches for the Management of a Difficult Clinical Entity

Avritscher¹,

Madoff²,

Ramírez³

et al. 2004

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“…There have been a handful of reports of complete resolution of ureteric fistula and/or ureteric stricture by this method alone, when the JJ stent is left indwelling for 4–8 weeks . Most UVFs after gynecological injury are not mild, and recurrence of vaginal leakage is noted following removal of the JJ stent after an interval of time in many patients . Memokath stenting for ureteric stricture has previously been reported with some success; however, its use for UVF is less well defined.…”

Section: Discussionmentioning

confidence: 99%

“…24,25 Most UVFs after gynecological injury are not mild, and recurrence of vaginal leakage is noted following removal of the JJ stent after an interval of time in many patients. 26,27 Memokath stenting for ureteric stricture has previously been reported with some success; however, its use for UVF is less well defined. There is one report of success in the setting of UVF at 10 months' follow up; however, the longevity of this as a treatment option for stricture resolution and sealing of fistulation is unknown.…”

Section: Discussionmentioning

confidence: 99%

Incidence, type and management of ureteric injury associated with vesicovaginal fistulas: Report of a series from a specialized center

et al. 2019

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Objectives To report a large series of vesicovaginal fistula, and to assess the incidence of ureteric injury in association with vesicovaginal fistula. Methods We retrospectively reviewed a prospective database of patients with vesicovaginal fistula referred to our center between 2004 and 2016. Data on patient demographics, fistula etiology, mode of repair, and any associated ureteric injury and its treatment were noted. Results Overall, 116 patients (median age 49 years, range 23–88 years) were referred for management of vesicovaginal fistula during the study period. Four of these patients (3.4%) had associated ureteric injury, one of whom had bilateral injury. Ureteric obstruction alone was noted in two patients, ureterovaginal fistula alone in one patient, and bilateral ureteric obstruction and ureterovaginal fistula in one patient. All ureteric injuries were managed with simultaneous reimplantation into the bladder at the time of vesicovaginal fistula repair. Five patients had post‐radiotherapy vesicovaginal fistula, and the remainder were post‐surgical. Three patients with post‐radiotherapy vesicovaginal fistula proceeded to primary diversion. Conclusions Ureteric injury is far less common than previously reported, occurring in <5% of patients presenting with vesicovaginal fistula. It can be successfully managed, and it remains the major indication for abdominal repair of vesicovaginal fistula.

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“…In another report, ureters were clipped percutaneously using stainless‐steel clips guided through a 24 F sheath, resulting in complete resolution of leakage in seven of eight women who had the procedure [2]. The only patient who did not have complete dryness had a complex fistula with an enterocutaneous component.…”

Section: Discussionmentioning

confidence: 99%

“…The mean follow‐up was 7 (0.5–17) months. Two patients who missed their routine appointment for nephrostomy exchange had recurrent fistulous drainage when their nephrostomy tubes became obstructed; this resolved after catheter exchange [2].…”

Section: Discussionmentioning

confidence: 99%

Ureteric embolization with stainless‐steel coils for managing refractory lower urinary tract fistula: a 12‐year experience

et al. 2006

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Patients were then managed by long-term nephrostomy drainage until death or definitive reconstructive surgery. RESULTSIn all, 29 patients (23 women and six men; mean age 59 years, SD 16) were identified who had urinary fistulae that were refractory to nephrostomy drainage alone. One patient had a history of severe perineal trauma and the remaining 28 had a history of cancer. Seventeen fistulae occurred in the setting of previous surgery, 20 patients had received adjunctive pelvic irradiation and 11 had had chemotherapy. In all, 52 ureters were embolized; occlusion was successful in all cases, with complete or near-complete ( < 1 pad/day) dryness within 3 days. No repeat embolization was required and there were no significant complications. Two patients were lost to follow-up. Three patients had definitive urinary diversion surgery and currently are well. One patient is alive and living with nephrostomy tubes; 23 patients have died. CONCLUSIONUreteric embolization is a viable option for managing complex lower urinary tract fistulae in patients with a poor performance status. It can be used as definitive management in patients with a limited lifeexpectancy or as a temporary measure in those for whom another management plan is anticipated. KEYWORDS urinary fistula, interventional radiology, ureteric embolization OBJECTIVETo report our 12-year experience with radiological treatment (ureteric embolization) for refractory urinary fistula, as malignancy, radiation therapy, and/or chronic inflammation increase the risk of lower urinary tract fistula after surgical urinary diversion, which can lead to significant morbidity, and for patients who are not surgical candidates permanent nephrostomy drainage and ureteric embolization offer an alternative form of urinary diversion. PATIENTS AND METHODSWe retrospectively reviewed patients who had ureteric occlusion for refractory urinary fistula at our institution between 1993 and 2005. Stainless-steel coils, with or without gelatine sponge, were placed antegradely through a percutaneous nephrostomy tract.

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Percutaneous Ureteral Clipping: Long-term Results and Complications

Cited by 7 publications

References 13 publications

Fistulas of the Lower Urinary Tract: Percutaneous Approaches for the Management of a Difficult Clinical Entity

Fistulas of the Lower Urinary Tract: Percutaneous Approaches for the Management of a Difficult Clinical Entity

Incidence, type and management of ureteric injury associated with vesicovaginal fistulas: Report of a series from a specialized center

Ureteric embolization with stainless‐steel coils for managing refractory lower urinary tract fistula: a 12‐year experience

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