Ureteral Interventions

ABSTRACT

The pelvic course of the ureter with its close proximity to the iliac artery, pelvic viscera, and other structures predispose to fistula formation. Surgical management of lower urinary tract fistulas is difficult and often ineffective. Nonvascular lower urinary tract fistulas can be managed by urinary diversion with percutaneous nephrostomy to allow for fistula healing. If this fails, ureteral embolization can be very effective; however, this should be preceded by careful evaluation and discussion with the patient as this intervention results in irreversible ureteral occlusion necessitating a diverting nephrostomy catheter indefinitely. A ureteroarterial fistula is a distinct entity compared with nonvascular fistulas with a different approach to management; it can be managed by exclusion of the fistula by endovascular placement of a stent graft across the arterial component of the fistula.

KEYWORDS

Fistula - embolization - ureter - kidney - nephrostomy

REFERENCES

• 1 Avritscher R, Madoff D C, Ramirez P T et al. Fistulas of the lower urinary tract: Percutaneous approaches for the management of a difficult clinical entity.  Radiographics. 2004;  24 (suppl 1) S217-S236
• 2 Bing K T, Hicks M E, Figenshau R S et al.. Percutaneous ureteral occlusion with use of Gianturco coils and gelatin sponge. Part I. Swine model.  J Vasc Interv Radiol. 1992a;  3 (2) 313-317
• 3 Bing K T, Hicks M E, Picus D, Darcy M D. Percutaneous ureteral occlusion with use of Gianturco coils and gelatin sponge. Part II. Clinical experience.  J Vasc Interv Radiol. 1992;  3 (2) 319-321
• 4 Shindel A W, Zhu H, Hovsepian D M, Brandes S B. Ureteric embolization with stainless-steel coils for managing refractory lower urinary tract fistula: a 12-year experience.  BJU Int. 2007;  99 (2) 364-368
• 5 Adamo R, Saad WEA, Brown D B. Percutaneous ureteral interventions.  Tech Vasc Interv Radiol. 2009;  12 (3) 205-215
• 6 Quillin S P, Darcy M D, Picus D. Angiographic evaluation and therapy of ureteroarterial fistulas.  AJR Am J Roentgenol. 1994;  162 (4) 873-878
• 7 van den Bergh R C, Moll F L, de Vries J P, Yeung K K, Lock T M. Arterio-ureteral fistula: 11 new cases of a wolf in sheep's clothing.  J Urol. 2008;  179 (2) 578-581
• 8 Kerns D B, Darcy M D, Baumann D S, Allen B T. Autologous vein-covered stent for the endovascular management of an iliac artery-ureteral fistula: case report and review of the literature.  J Vasc Surg. 1996;  24 (4) 680-686
• 9 Bergqvist D, Pärsson H, Sherif A. Arterio-ureteral fistula—a systematic review.  Eur J Vasc Endovasc Surg. 2001;  22 (3) 191-196
• 10 Darcy M. Uretro-arterial fistulas.  Tech Vasc Interv Radiol. 2009;  12 (3) 216-221
• 11 Vandersteen D R, Saxon R R, Fuchs E, Keller F S, Taylor Jr L M, Barry J M. Diagnosis and management of ureteroiliac artery fistula: value of provocative arteriography followed by common iliac artery embolization and extraanatomic arterial bypass grafting.  J Urol. 1997;  158 (3 Pt 1) 754-758