Transrenal ureteral occlusion using the Amplatzer vascular plug II: a new interventional treatment option for lower urinary tract fistulas.

PURPOSE

This study was designed to evaluate the results of a novel technique for transrenal ureteral occlusion using an Amplatzer vascular plug (AVP) II in patients with urinary fistulas.

METHODS

We retrospectively evaluated the results of transrenal occlusion of 15 ureters in 9 hospitalized patients [8 females, 1 male, mean age 64 (range 52-79) years] suffering from pelvic malignancy (4 cervix-carcinomas, 3 bladder-carcinomas, 1 colorectal carcinoma, and 1 vulva-carcinoma). Seven patients were treated for urinary fistulas (4 ureteroenteral, 3 vesicovaginal); the others showed ileum-conduit-insufficiency and Mainz-pouch incontinence, respectively. From 2008 to 2009, an AVP was used in combination with coils and tissue adhesive (n = 5). Since 2009, ureteral occlusions were performed using a latex-covered AVP (n = 10). All patients had previous nephrostomy with only incomplete clinical improvement.

RESULTS

Fourteen of 15 interventions were technically successful. Four of five ureters occluded with a combination of AVP, coils, and tissue adhesive were permanently sealed after a single procedure, whereas one showed slight leakage. After placement of two additional coils 20 days later, permanent occlusion was achieved [mean follow-up 195 (range 30-687) days]. Nine of ten ureters occluded with a latex-covered AVP were completely sealed after a single intervention [mean follow-up 152 (range 10-462) days]. In one case, the latex-cover dislocated during implantation. The AVP alone failed to provide complete dryness. There were no dislocations of the AVP or other major complications.

CONCLUSIONS

Transrenal ureteral occlusion using an AVP is a practical, simple, and quick method and can be advantageous in palliative patients suffering from pelvic malignancy.