TY - JOUR
T1 - Fistulas of the lower urinary tract
T2 - Percutaneous approaches for the management of a difficult clinical entity
AU - Avritscher, Rony
AU - Madoff, David C.
AU - Ramirez, Pedro T.
AU - Wallace, Michael J.
AU - Ahrar, Kamran
AU - Morello, Frank A.
AU - Gupta, Sanjay
AU - Murthy, Ravi
AU - Wright, Kenneth C.
AU - Hicks, Marshall E.
N1 - Copyright:
Copyright 2020 Elsevier B.V., All rights reserved.
PY - 2004/10
Y1 - 2004/10
N2 - Fistulas of the lower urinary tract are uncommon conditions that may occur spontaneously or after therapy in patients with various pelvic abnormalities. When present, these fistulas are associated with urine leakage, which is often socially distressing and disabling. Unfortunately, factors that lead to the formation of genitourinary fistulas often increase their complexity or preclude surgical repair. A high failure rate is associated with surgical repair, and many patients are not optimal surgical candidates. For such patients, a percutaneous treatment approach is highly desirable. Percutaneous ureteral occlusion combined with insertion of a functioning nephrostomy tube allows complete diversion of urine in those patients in whom nephrostomy alone does not provide adequate relief. Many approaches to percutaneous ureteral occlusion have been used with variable success, including coils and gelatin sponge, isobutyl-2-cyanoacrylate, detachable balloons, radiofrequency electrocautery, ureteral clipping, and solid and soft polymer agents. Furthermore, percutaneous or retrograde ureteral stents may be used to preserve antegrade urine flow, and surgical options are also available. It is essential that the interventional radiologist involved in the care of these patients be familiar with these different techniques as well as with the limitations, pitfalls, and possible complications of their use.
AB - Fistulas of the lower urinary tract are uncommon conditions that may occur spontaneously or after therapy in patients with various pelvic abnormalities. When present, these fistulas are associated with urine leakage, which is often socially distressing and disabling. Unfortunately, factors that lead to the formation of genitourinary fistulas often increase their complexity or preclude surgical repair. A high failure rate is associated with surgical repair, and many patients are not optimal surgical candidates. For such patients, a percutaneous treatment approach is highly desirable. Percutaneous ureteral occlusion combined with insertion of a functioning nephrostomy tube allows complete diversion of urine in those patients in whom nephrostomy alone does not provide adequate relief. Many approaches to percutaneous ureteral occlusion have been used with variable success, including coils and gelatin sponge, isobutyl-2-cyanoacrylate, detachable balloons, radiofrequency electrocautery, ureteral clipping, and solid and soft polymer agents. Furthermore, percutaneous or retrograde ureteral stents may be used to preserve antegrade urine flow, and surgical options are also available. It is essential that the interventional radiologist involved in the care of these patients be familiar with these different techniques as well as with the limitations, pitfalls, and possible complications of their use.
KW - Fistula, genitourinary system, 80.245
KW - Fistula, therapeutic embolization, 80.1269
KW - Ureter, abnormalities, 82.245
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U2 - 10.1148/rg.24si045508
DO - 10.1148/rg.24si045508
M3 - Article
C2 - 15486242
AN - SCOPUS:7644223218
SN - 0271-5333
VL - 24
SP - S217-S236
JO - Radiographics
JF - Radiographics
IS - SPEC. ISS.
ER -