Endourologic management of urinary fistulae

Historically, aggressive surgical exploration of renal fistulae has been associated with a 20% nephrectomy rate. We evaluated the role of minimally invasive techniques in the management of urinary fistulae.

A retrospective review identified 10 renal fistulae in nine patients. Six renal-cutaneous, two renal-colonic, and two renal-pleural fistulae were referred for evaluation and treatment.

Five men and four women (mean age 54 years, range 32-76) were referred to the University of California, San Francisco Urinary Stone Center from 1988 to 1996. Of the six renal-cutaneous fistulae, four were spontaneous and two were iatrogenic. The iatrogenic fistulae occurred after an open pyelolithotomy (1) and a renal exploration performed after extracorporeal shock wave lithotripsy (1). The spontaneous fistulae resulted from obstructing calyceal calculi (2), infundibular stenosis (1), and obstructed nephrostomy tube (1). The two renal-colonic fistulae resulted from percutaneous nephrolithotomies, and the two renal-pleural fistulae developed after renal surgery. Eight of 10 fistulae resolved with minimally invasive endoscopic techniques and relief of urinary obstruction. One nephrectomy was performed for a small nonfunctioning kidney after failed open pyelolithotomy. One patient refused all treatment and the fistula resolved spontaneously.

Conservative management of both spontaneous and iatrogenic renal fistulae is possible by relieving urinary obstruction and using minimally invasive endoscopic techniques. Low nephrectomy rates can be expected using these methods.