title: Transrenal Antegrade Ureteral Occlusion: Clinical Assessment of Indications, Technique and Outcomes.
abstract: OBJECTIVE
  We describe the indications, technique and outcome of transrenal antegrade ureteral occlusion.
  
  
  METHODS
  An institutional database was used to retrospectively identify patients who underwent image guided transrenal ureteral occlusion between December 1998 and March 2014. Platinum coils were deployed into the distal ureter or 4 to 5 cm proximal to the site of ureteral leak. Gelfoam® pledgets were injected in the ureter at the level of the coils. Additional coils were deployed to trap the pledgets in the distal ureter.
  
  
  RESULTS
  Between December 1998 and March 2014, 12 men and 12 women with a mean age of 69 years (range 45 to 87) underwent fluoroscopically guided, transrenal antegrade ureteral occlusion for intractable hematuria in 7 and urinary fistula in 17. A total of 39 ureteral units were occluded, including 3 on the right side, 6 on the left side and 30 that were bilateral. Ureteral occlusion was successful in 35 of 37 renal units (94.6%) as determined by post-procedure antegrade nephrostogram and resolution of clinical symptoms of hematuria and/or urinary leakage. Repeat occlusion was necessary to achieve total ureteral occlusion in 2 of 35 renal units (5.7%).
  
  
  CONCLUSIONS
  Percutaneous ureteral occlusion with platinum coils and Gelfoam offers a treatment option for patients with refractory urinary fistula and intractable hematuria in whom standard methods of urinary diversion fail.
authors.affiliation: Division of Interventional Radiology, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts. Electronic address: nasvadi@mednet.ucla.edu.
authors.forename: Nazanin H
authors.initials: NH
authors.lastname: Asvadi
authors.affiliation: Division of Interventional Radiology, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Ronald S
authors.initials: RS
authors.lastname: Arellano
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006417:Hematuria / Q000175:diagnosis / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014548:Urinary Fistula / Q000175:diagnosis / Q000628:therapy*; D014567:Urography
keywords: fistula; hematuria; kidney; ureter; urinary diversion