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

Abstract

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.

Vesicovaginal Fistula: Diagnosis and Management

“…For the above groups, urinary diversion, either in the form of a urinary conduit or a continent reservoir, can be considered. Fistulas in patients who are not candidates for surgical intervention may be managed by percutaneous ureteral occlusion and permanent nephrostomy [24]. In the developing world, where catheters and ostomy appliances are either too expensive or completely unavailable, continent urinary diversion or incontinent urostomies are often not practical, which present ethical issues with the alternative treatments [25].…”

Vesicocutaneous Fistula Following Radiation and Surgery for the Treatment of Rectal Cancer

“…Conservative measures include IDC insertion and percutaneous nephrostomies to allow adequate healing of the tract [8]. Ureteric embolization can also be utilised with percutaneous nephrostomies if treatment fails or in the situation of poor life expectancy [9]. This approach may be more favourable in the setting of radiation-induced VCF as the fibrosis and overall tissue viability may increase the likelihood of further complications.…”

Images – Urinary tract reconstruction following ureteral coil embolization for ureterovaginal fistula in a young female patient

“…Percutaneous endoureteral coil embolization for ureterovaginal fistula has been described in the literature for the management of refractory complex lower urinary tract fistulas in patients with persistent urinary leakage despite surgical urinary diversion, poor performance status, limited life-expectancy or as a temporizing measure prior to definitive surgical management. [2][3][4] As well, its use as palliation for urinary incontinence in patients with advanced pelvic malignancy has been described with excellent outcomes. 5 The use of this embolization procedure outside of these parameters is not well described given the lack of indications beyond symptom palliation.…”