Transrenal Ureteral Occlusion Using the Amplatzer Vascular Plug II: A New Interventional Treatment Option for Lower Urinary Tract Fistulas

Abstract

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