title: Ureteric embolization with stainless-steel coils for managing refractory lower urinary tract fistula: a 12-year experience.
abstract: OBJECTIVE
  To 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.
  
  
  METHODS
  We 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. Patients were then managed by long-term nephrostomy drainage until death or definitive reconstructive surgery.
  
  
  RESULTS
  In 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.
  
  
  CONCLUSIONS
  Ureteric 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 life-expectancy or as a temporary measure in those for whom another management plan is anticipated.
authors.affiliation: Department of Surgery, Division of Urology, Washington University, St. Louis, MO, USA. retinol13@yahoo.com
authors.forename: Alan W
authors.initials: AW
authors.lastname: Shindel
authors.forename: Hui
authors.initials: H
authors.lastname: Zhu
authors.forename: David M
authors.initials: DM
authors.lastname: Hovsepian
authors.forename: Steven B
authors.initials: SB
authors.lastname: Brandes
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications*; D009403:Nephrostomy, Percutaneous / Q000379:methods; D012189:Retrospective Studies; D055502:Secondary Prevention; D013193:Stainless Steel; D016896:Treatment Outcome; D014548:Urinary Fistula / Q000209:etiology / Q000378:metabolism* / Q000628:therapy*
chemical_list: D013193:Stainless Steel