title: Urinary Tract Fistulas: Transrenal Reversible Ureteral Occlusion With Detachable Semicompliant Balloons.
abstract: OBJECTIVE
  To evaluate transrenal reversible ureteral occlusion with detachable balloons in patients with treatment-refractory urinary tract fistulas.
  
  
  METHODS
  From September 2009 to September 2013, reversible occlusion of 18 ureters (7 men, 3 women; 27-74 years) with treatment-refractory urinary leakage mostly because of tumor disease or iatrogenic surgical injury was performed. Nephrostomy was exchanged fluoroscopically into an 8F or 9F sheath, which was introduced into the ureter to the point of intended balloon inflation. The prepared semicompliant balloon on a special microcatheter was introduced into the sheath, inflated, and detached. A nephrostomy tube was placed in the pelvicalyceal system. After healing of the fistulas, urinary flow was restored by transureteral removal or computed tomography-guided percutaneous puncture of the balloons.
  
  
  RESULTS
  Hundred percent successful placement of the balloons and initial urinary fistula occlusion was achieved (18 of 18 ureters). One patient was lost during follow-up. Six of the remaining 9 patients needed reocclusion because of balloon dislocation or deflation (secondary technical success 83%; 5 of 6 ureters). A z-shaped ureter made reocclusion unsuccessful. Mean duration of ureteral occlusion was 74 days (5-250 days). After healing of the fistulas, intentional ureteral recanalization by percutaneous puncture or transureteral balloon removal was feasible. Anterograde urination was achieved in 5 of 9 patients (clinical success rate 55%). Four fistulas did not heal. Two patients died from their underlying disease.
  
  
  CONCLUSIONS
  Transrenal reversible off-label ureteral occlusion with semicompliant detachable balloons is feasible with a high technical success rate. Long-term ureteral occlusion can be achieved in nearly all patients with a moderate clinical success rate in heavily diseased patients.
authors.affiliation: Department of Radiology, University Hospital Cologne, Cologne, Germany.
authors.forename: Mareike
authors.initials: M
authors.lastname: Franke
authors.affiliation: Department of Urology, University Hospital Cologne, Cologne, Germany.
authors.forename: Sabine
authors.initials: S
authors.lastname: Winand
authors.affiliation: Department of Radiology, University Hospital Cologne, Cologne, Germany.
authors.forename: De-Hua
authors.initials: DH
authors.lastname: Chang
authors.affiliation: Department of Urology, University Hospital Cologne, Cologne, Germany.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Wille
authors.affiliation: Department of Radiology, University Hospital Cologne, Cologne, Germany.
authors.forename: David
authors.initials: D
authors.lastname: Maintz
authors.affiliation: Department of Radiology, University Hospital Cologne, Cologne, Germany. Electronic address: christopher.bangard@uk-koeln.de.
authors.forename: Christopher
authors.initials: C
authors.lastname: Bangard
mesh_terms: D000328:Adult; D000368:Aged; D004867:Equipment Design; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014513:Ureter; D014548:Urinary Fistula / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000295:instrumentation / Q000379:methods