Therapeutic ureteric embolisation

Abstract

Vesico-vaginal fistula with its associated incontinence is an unpleasant and distressing condition and when it occurs as a result of pelvic malignant disease, surgical management can be very difficult. We describe a case in which percutaneous transrenal embolisation of the ureter abolished the incontinence and obviated the need for further surgery. The technique has been used successfully in a previous similar case (Gunther et al, 1979). A 68-year-old woman was found to have an endometrial carcinoma in 1980. The tumour had already invaded locally into the pelvis and the initial treatment consisted of surgical removal of as much malignant tissue as possible. One year later she returned with evidence of extensive local recurrence for which she received pelvic radiotherapy. She remained symptom-free until 1983 when she presented with incontinence due to a vesico-vaginal fistula. There was clinical evidence of further pelvic tumour and an intravenous urogram showed no function in the right kidney, a normal left kidney and ureter and extravasation of contrast medium from the bladder to the vagina (Fig. 1). At laparotomy the recurrence of her carcinoma was deemed inoperable, so both ureters were ligated and the next day a percutaneous catheter nephrostomy of the left kidney was performed in the radiology department. Satisfactory urinary drainage was established and the patient was discharged five days later with no evidence of urinary incontinence.