title: Minimally invasive radiologic techniques in the treatment of uretero-enteric fistulas.
abstract: OBJECTIVE
  The goal of this study was to assess the efficacy of minimally invasive interventional radiologic (IR) techniques in the management of uretero-enteric fistulae in comparison to established surgical modalities.
  
  
  METHODS
  Twenty-five patients (16 men, 9 women) with a mean age of 47 (range: 19-77 years) with uretero-enteric fistulae were treated with percutaneous nephrostomy, double "J" stent, radiologic uretero-neocystostomy, and radiologic uretero-pyelocalicostomy. All patients had a single fistula each. Uretero-enteric fistulas were due to direct or iatrogenic trauma in 14 patients (uretero-ileal fistulas, n=6; uretero-colonic fistulas, n=4; uretero-duodenal fistulas, n=2; uretero-pancreatic fistula, n=1; uretero-fallopian tube, n=1), complications of pelvic neoplasms in 4 patients (uretero-sigmoid fistulas, n=4), inflammatory disease in 4 patients (uretero-ileal fistulas, n=2; uretero-sigmoid fistulas, n=2), and avascular necrosis of renal transplants in 3 patients (uretero-sigmoid fistulas, n=3).
  
  
  RESULTS
  Drainage by percutaneous nephrostomy and double "J" stent resulted in closure of 8 uretero-enteric fistulae over 7-16 weeks. Four uretero-enteric fistulae obliterated after re-routing urine flow using 3 radiologic uretero-neocystostomies and one IR pyelocalicostomy. In other patients, flow through the fistulae was substantially decreased by five double "J" stents and 3 percutaneous nephrostomies. The duration of inpatient hospitalization was significantly less for patients managed successfully by IR procedures than those treated by surgical modalities, 5.07 versus 10.5 days mean (P<0.05).
  
  
  CONCLUSIONS
  IR procedures provided definitive treatment in 48% of uretero-enteric fistulae at significantly reduced inpatient hospitalization and cost. As palliative treatment, it improved the quality of life.
authors.affiliation: Department Radiology, Tulane School of Medicine, New Orleans, LA, United States; Johns Hopkins Medical Institutions, 600, North Wolfe Street, Baltimore, MD 21205, United States; Tulane University Hospital, 1415, Tulane Avenue, New Orleans, LA 70112, United States.
authors.forename: E K
authors.initials: EK
authors.lastname: Lang
authors.affiliation: Department of Radiology, State University of New York Downstate Medical Center, 451, Clarkson Avenue, Brooklyn, NY 11203, United States. Electronic address: aallaei@gmail.com.
authors.forename: A
authors.initials: A
authors.lastname: Allaei
authors.affiliation: Department of Radiology, State University of New York Downstate Medical Center, 451, Clarkson Avenue, Brooklyn, NY 11203, United States.
authors.forename: L
authors.initials: L
authors.lastname: Robinson
authors.affiliation: Department of Radiology, State University of New York Downstate Medical Center, 451, Clarkson Avenue, Brooklyn, NY 11203, United States.
authors.forename: J
authors.initials: J
authors.lastname: Reid
authors.affiliation: Department of Radiology, State University of New York Downstate Medical Center, 451, Clarkson Avenue, Brooklyn, NY 11203, United States.
authors.forename: H
authors.initials: H
authors.lastname: Zinn
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007412:Intestinal Fistula / Q000000981:diagnostic imaging* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D015641:Radiography, Interventional; D012189:Retrospective Studies; D016896:Treatment Outcome; D014515:Ureteral Diseases / Q000000981:diagnostic imaging* / Q000601:surgery*; D014548:Urinary Fistula / Q000000981:diagnostic imaging* / Q000601:surgery*; D055815:Young Adult
keywords: Fistula; Nephrostomy; Stents; Uretero-enteric; Uretero-neocystostomy