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Six patients (mean age, 57.7 y ± 19.7) with persistent urinary fistulae underwent 7 urinary tract embolizations with AMPLATZER Vascular Plugs (AVPs) and glue: 5 with concomitant cavity obliteration with glue and 2 without. A single procedure was successful in resolving urinary leakage in 5 patients (71%) at a mean follow-up of 27.3 wk ± 31.5 (median, 9.7 wk; range, 4.9-80 wk). Repeat cavity embolization was required in 2 instances to achieve clinical success. Mean survival was 42.3 wk (median, 16.4 wk; range, 11.7-104 wk). Combined AVP and glue embolization may prove to be a primary approach in the control of persistent fistulae., (Copyright © 2020 SIR. Published by Elsevier Inc. All rights reserved.)

Purpose: To describe outcomes of transrenal embolization with vascular plugs and ethylene vinyl alcohol (EVOH) in a case series of patients with refractory urinary leak or fistula., Materials and Methods: Fifteen ureteral occlusions performed over 53 months in 9 consecutive patients (56% female; mean age 61 y; range, 45-80 y) were reviewed retrospectively. The main indication was palliation for refractory fistula or leak in the setting of malignancy not responding to urine diversion by percutaneous nephrostomy tube or nephroureteral stent. Transrenal ureteral occlusion was performed using EVOH injected between vascular plugs placed distal and proximal to the leak or fistula., Results: Technical success was 100%. Considerable reduction of urine leak or symptoms (clinical success) was achieved in 64% of ureters after mean follow-up of 105 days (range, 0-632 d). Complete ureteral occlusion on follow-up anterograde nephrostogram (imaging success) was achieved in 60% of ureters after mean follow-up of 139 days (range, 0-643 d). One patient with distal ureterovesical junction-perineal fistula had continued leak despite complete proximal occlusion of ureter owing to retrograde urine reflux from the bladder and was treated with endoscopic injection of intramural calcium hydroxyapatite to the ureteral segment distal to the fistula. Three ureters (33%) in 2 patients with vesicovaginal fistula had recanalization, requiring additional proximal embolization, yielding secondary success rates of 91% (clinical) and 90% (imaging) per ureter. One minor urinary tract infection and no major complications occurred., Conclusions: Transrenal anterograde ureteral occlusion using EVOH between vascular plugs could be considered a relatively safe and potentially valuable treatment option for refractory ureteral fistulae., (Copyright © 2019 SIR. Published by Elsevier Inc. All rights reserved.)

Purpose: To retrospectively evaluate the safety and efficacy of the percutaneous obliteration of urinary leakage after partial nephrectomy (PN) using coils and N-butyl-cyanoacrylate (NBCA)., Materials and Methods: Data of 10 consecutive patients who underwent percutaneous obliteration of urinary leakage after PN using coil and NBCA between February 2016 and May 2018 were retrospectively reviewed. A urinary fistulography was performed via the drainage catheter. If the fistulous tract was clearly visualized, super-selective embolization of the fistulous tract with coils and urinoma cavity sealing with NBCA was performed. In cases where the fistulous tract could not be clearly visualized, only urinoma cavity sealing was performed. Outcomes and complications were assessed by reviewing medical records and computed tomography (CT)., Results: In 7 (70%) patients who showed obvious urinary fistulous tract, coil embolization of the urinary fistulous tract, followed by sealing of the urinoma cavity with NBCA, was performed. Obliteration of the urinoma without coil embolization of the fistula tract was performed in 3 patients (30%) in whom a distinct fistulous tract could not be visualized. The median number of treatment sessions required to achieve clinical success was 1 (range, 1-5). Four patients underwent multiple repeated procedure with successful results. All patients showed gradual decrease in size or complete disappearance of urinoma on follow-up CT without evidence of urinary leakage during the follow-up period (mean, 44.6 weeks; range, 11-117 weeks). There were no procedure-related complications., Conclusions: Percutaneous obliteration of urinary leakage after PN using coils and NBCA is safe and effective., (Copyright © 2019 SIR. Published by Elsevier Inc. All rights reserved.)

The authors report two cases of stent-assisted embolization (SAE) in the aorta. In one case, SAE was performed for treatment of a pseudoaneurysm; the procedure consisted of stent placement and embolization with an AMPLATZER Vascular Plug and detachable coils through the stent struts. In the second case, SAE was performed to stop acute bleeding from an aortoureteral fistula. Before SAE in this case, the aortic bifurcation was reconstructed with self-expandable and balloon-expandable stents. SAE was technically successful in both cases. SAE for aortic pathologic processes may be useful in selected cases as an alternative to surgery or endovascular stent-graft therapy., (Copyright © 2011 SIR. Published by Elsevier Inc. All rights reserved.)

The present report describes a case of urostomy breakdown and failed urinary diversion with bilateral nephrostomy drainage treated with transrenal placement of a covered stent. Covered stents can be used successfully for the exclusion of ureterocutaneous fistulas and urostomies with the potential for ureteric occlusion.

Purpose: To develop a device for percutaneous transrenal ureteral occlusion., Materials and Methods: The device was a double-body Gianturco-Rösch biliary stent constrained at the junction of the two stents to create an hourglass shape. One stent was coated with silicone. One device was percutaneously placed in each of nine pigs through a 9-F Teflon sheath. Urographic and hematologic follow-up was performed for up to 12 weeks., Results: Seven pigs showed immediate, complete ureteral occlusion, and two pigs exhibited persistent incomplete high-grade obstruction. All animals exhibited varying degrees of hydronephrosis and hydroureter. No device migration was noted. Minor complications were encountered during device placement in three pigs. Mucosal folds and villus-like projections that arose from the lamina propria protruded into the lumen of the ureter at the cranial end of the covered stent and around the wire of the caudal stent. Varying degrees of mural inflammation and edema were noted., Conclusion: Transrenal ureteral occlusion with the described device appears to be a viable method for treating urinary fistulas.

Purpose: The effectiveness of transrenal ureteral occlusion was evaluated., Patients and Methods: Transrenal ureteral occlusions were performed in 83 ureters of 76 patients. Thirty-one ureters were occluded with use of tissue adhesive, which was secured in place with Gianturco coils in 21. Fifty-two ureters were occluded by means of silicone-filled, detachable latex balloons. Average follow-up was 3.6 months (range, 1 week to 38 months) for patients treated with the tissue adhesive and 7.9 months (range, 1 week to 61 months) for patients treated with the detachable balloons., Results: Seventeen (55%) of the 31 ureters occluded with tissue adhesive and 36 (69%) of the 52 ureters occluded with detachable balloons were permanently sealed after a single procedure. In 30 ureters, the occlusion procedure had to be repeated. The average duration of temporarily effective occlusions was 2.5 weeks when tissue adhesive was used and 19.5 weeks with detachable balloons. Complications were observed in 10 (7%) of 138 interventions. Only four of these were considered significant: two perforations occurred at the ureteropelvic junction, septicemia was seen after one procedure, and damage to a small intrarenal artery necessitated selective embolization in one patient., Conclusions: In selected patients, transrenal ureteral occlusion can effectively and safely interrupt urinary flow toward the bladder. Detachable balloons were superior to tissue adhesive as an occluding agent.

A previous report described the use of coils and gelatin sponge pledgets as a means of producing ureteral occlusion to achieve urinary diversion in patients with urinary fistulas. The authors have performed this procedure in nine ureters of six patients. Five of the patients had urinary leaks with extensive pelvic tumor, and one had severe chronic cystitis. Ureters were occluded with use of Gianturco coils and gelatin sponge pledgets placed via a sheath through a percutaneous nephrostomy tract. The procedure was successful in all patients as judged by means of antegrade nephrostogram or intravenous pyelogram and by marked improvement or complete resolution of symptoms.