title: Ureteric embolization for lower urinary tract fistulae: use of two amplatzer vascular plugs and N-butyl cyanoacrylate employing the "sandwich" technique.
abstract: OBJECTIVE
  This study describes and evaluated the effectiveness of occluding distal ureters in the clinical setting of urinary vaginal (vesicovaginal or enterovesicovaginal) fistulae utilizing a new technique which combines Amplatzer vascular plugs and N-butyl cyanoacrylate.
  
  
  METHODS
  This is a retrospective study (January 2007-December 2010) of patients with urinary-vaginal fistulae undergoing distal ureter embolization utilizing an Amplatzer-N-butyl cyanoacrylate-Amplatzer sandwich technique. An 8-12-mm type-I or type-II Amplatzer vascular plug was delivered using the sheath and deployed in the ureter distal to the pelvic brim. Instillation of 0.8-1.5 cc of N-butyl cyanoacrylate into ureter proximal to the Amplatzer plug was performed. This was followed by another set of 8-12-mm type-I or type-II Amplatzer vascular plugs in a technique referred to as the "sandwich technique."
  
  
  RESULTS
  Five ureters in three patients were occluded utilizing the above-described technique during the 4-year study period. Mean maximum size Amplatzer used per ureter was 10.8 mm (range, 8-12). One ureter required three Amplatzer plugs and the rest required two. Two patients (3 ureters) were clinically successful with complete resolution of symptoms in 36-48 h. The third patient (2 ureters) was partly successful and required a second Amplatzer-N-butyl cyanoacrylate sandwich technique embolization. The mean clinical follow-up was 11.3 months (range, 1.7-29.2).
  
  
  CONCLUSIONS
  The Amplatzer-N-butyl cyanoacrylate-Amplatzer sandwich technique for occluding the distal ureter is safe and effective with a quick (probably due to the N-butyl cyanoacrylate) and durable (probably due to the Amplatzer plugs) clinical response.
authors.affiliation: Department of Radiology & Medical Imaging, Division of Vascular Interventional Radiology, University of Virginia Health System, 1215 Lee St, PO Box 800170, Charlottesville, VA 22908, USA. ws6r@virginia.edu
authors.forename: Wael E A
authors.initials: WE
authors.lastname: Saad
authors.forename: S
authors.initials: S
authors.lastname: Kalagher
authors.forename: U C
authors.initials: UC
authors.lastname: Turba
authors.forename: S S
authors.initials: SS
authors.lastname: Sabri
authors.forename: A-W
authors.initials: AW
authors.lastname: Park
authors.forename: J
authors.initials: J
authors.lastname: Stone
authors.forename: J F
authors.initials: JF
authors.lastname: Angle
authors.forename: A H
authors.initials: AH
authors.lastname: Matsumoto
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D004621:Embolization, Therapeutic / Q000379:methods*; D004659:Enbucrilate / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D012189:Retrospective Studies; D018570:Risk Assessment; D055989:Septal Occluder Device; D016896:Treatment Outcome; D014515:Ureteral Diseases / Q000628:therapy*; D001747:Urinary Bladder Fistula / Q000175:diagnosis / Q000628:therapy; D014546:Urinary Catheterization / Q000295:instrumentation / Q000379:methods; D014719:Vesicovaginal Fistula / Q000175:diagnosis / Q000628:therapy*
chemical_list: D004659:Enbucrilate