title: Combined percutaneous antegrade and cystoscopic retrograde approach in the treatment of distal ureteric fistulae.
abstract: OBJECTIVE
  To determine the efficacy of a cystoscopic approach, as definitive treatment of ureteral fistulae, after failure of antegrade ureteral stent insertion.
  
  
  METHODS
  Of 43 ureter fistulae encountered over 4 years, 10 postoperative and/or postradiotherapy fistulae could not be stented via an antegrade approach alone. A cystoscopic approach was used, with the antegrade approach available as back-up, if necessary.
  
  
  RESULTS
  In two patients the ureteral orifice could not be visualized cystoscopically, thus precluding the retrograde approach. In the eight remaining patients, the retrograde approach alone never allowed successful stenting. In six patients, combined antegrade and retrograde approaches permitted stent insertions. In three of those six patients, a complex catheterization procedure was necessary. In two patients the combined approach failed altogether. Therefore, 6 of 10 patients underwent a successful stenting procedure with the combined approach; all ultimately closed the fistula.
  
  
  CONCLUSIONS
  Antegrade stent insertion remains the treatment of choice for ureteral leaks. If the antegrade approach fails, the retrograde approach alone is not likely to be successful. Instead, a combination of both approaches often does succeed.
authors.affiliation: Department of Interventional Radiology, Institut Gustave Roussy, Villejuif, France.
authors.forename: T
authors.initials: T
authors.lastname: de Baere
authors.forename: A
authors.initials: A
authors.lastname: Roche
authors.forename: C
authors.initials: C
authors.lastname: Lagrange
authors.forename: A
authors.initials: A
authors.lastname: Denys
authors.forename: B
authors.initials: B
authors.lastname: Court
authors.forename: J
authors.initials: J
authors.lastname: Isapoff
authors.forename: P
authors.initials: P
authors.lastname: Pappas
mesh_terms: D000328:Adult; D000368:Aged; D003558:Cystoscopy / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009403:Nephrostomy, Percutaneous; D015642:Radiology, Interventional / Q000379:methods; D015607:Stents; D017211:Treatment Failure; D014515:Ureteral Diseases / Q000628:therapy*; D014546:Urinary Catheterization / Q000379:methods; D014548:Urinary Fistula / Q000628:therapy*; D014624:Vaginal Fistula / Q000628:therapy