title: Minimally invasive treatment of urinary fistulas using N-butyl-2-cyanoacrylate: a valid first line option.
abstract: BACKGROUND
  A few single case reports and only one clinical series have been published so far about the use of N-butyl-2-cyanoacrylate in the treatment of urinary fistulas persisting after conventional urinary drainage.
  
  
  METHODS
  We treated five patients with a mean age of 59.2 years presenting iatrogenic urinary fistulas which persisted following conventional drainage manouvres. There were 3 calyceal fistulas following open, laparoscopic and robotic removal of renal lesions respectively, one pelvic fistula after orthotopic ileal neobladder and a bilateral dehiscence of uretero-sigmoidostomy. We used open-end catheters of different sizes adopting a retrograde endoscopic approach for cyanoacrylate injection in the renal calyces, while a descending percutaneous approach via the pelvic drain tract and bilateral nephrostomies respectively was used for the pelvic fistulas. Fluoroscopic control was always used during the occlusion procedures. The amount of adhesive injected ranged between 2 and 5 cc and in one case the procedure was repeated. With a median follow-up of 11 months we observed clinical and radiological resolution in 4 cases (80%), while a recurrent and infected calyceal fistula after laparoscopic thermal renal damage during tumor enucleoresection required nephrectomy. No significant complications were documented.
  
  
  CONCLUSIONS
  In an attempt to spare further challenging surgery in patients that had been already operated on recently, minimally invasive occlusion of persistent urinary fistulas with N-butyl-2-cyanoacrylate represents a valid first line treatment, justified in cases when the urinary output is not excessive and there is a favorable ratio between the length and diameter of the fistulous tract.
authors.affiliation: Department of Urology, University of Pisa, Pisa, Italy. c.selli@med.unipi.it.
authors.forename: Cesare
authors.initials: C
authors.lastname: Selli
authors.forename: Maurizio
authors.initials: M
authors.lastname: De Maria
authors.forename: Michele
authors.initials: M
authors.lastname: Manica
authors.forename: Filippo Maria
authors.initials: FM
authors.lastname: Turri
authors.forename: Francesca
authors.initials: F
authors.lastname: Manassero
mesh_terms: D000368:Aged; D004621:Embolization, Therapeutic / Q000379:methods*; D004659:Enbucrilate / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D014014:Tissue Adhesives / Q000627:therapeutic use*; D016896:Treatment Outcome; D014548:Urinary Fistula / Q000175:diagnosis / Q000628:therapy*
chemical_list: D014014:Tissue Adhesives; D004659:Enbucrilate