Transrenal Antegrade Ureteral Occlusion: Clinical Assessment of Indications, Technique and Outcomes
Nazanin H Asvadi1, Ronald S Arellano1
1Division of Interventional Radiology, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts.
Insights
Transrenal antegrade ureteral occlusion using platinum coils and Gelfoam effectively treats intractable hematuria and urinary fistulas. This minimally invasive technique offers a successful alternative when standard urinary diversion methods fail.
Area of Science:
- Interventional Radiology
- Urology
- Nephrology
Background:
- Refractory urinary fistulas and intractable hematuria pose significant clinical challenges.
- Standard urinary diversion methods may not be suitable or effective for all patients.
Purpose of the Study:
- To describe the indications, technique, and outcomes of transrenal antegrade ureteral occlusion.
- To evaluate the efficacy of this procedure for managing complex urological conditions.
Main Methods:
- Retrospective analysis of patients undergoing image-guided transrenal ureteral occlusion (December 1998 - March 2014).
- Deployment of platinum coils in the distal ureter, followed by Gelfoam pledgets to occlude the ureteral lumen.
- Fluoroscopic guidance was used throughout the procedure.
Main Results:
- 12 men and 12 women (mean age 69) underwent the procedure for hematuria (n=7) or urinary fistula (n=17).
- Successful occlusion was achieved in 35 of 37 renal units (94.6%), confirmed by nephrostogram and symptom resolution.
- Repeat occlusion was required in only 5.7% of cases.
Conclusions:
- Percutaneous ureteral occlusion with platinum coils and Gelfoam is a viable treatment option.
- It provides an effective solution for refractory urinary fistula and intractable hematuria when other methods fail.
Purpose:
We describe the indications, technique and outcome of transrenal antegrade ureteral occlusion.
Materials And Methods:
An institutional database was used to retrospectively identify patients who underwent image guided transrenal ureteral occlusion between December 1998 and March 2014. Platinum coils were deployed into the distal ureter or 4 to 5 cm proximal to the site of ureteral leak. Gelfoam® pledgets were injected in the ureter at the level of the coils. Additional coils were deployed to trap the pledgets in the distal ureter.
Results:
Between December 1998 and March 2014, 12 men and 12 women with a mean age of 69 years (range 45 to 87) underwent fluoroscopically guided, transrenal antegrade ureteral occlusion for intractable hematuria in 7 and urinary fistula in 17. A total of 39 ureteral units were occluded, including 3 on the right side, 6 on the left side and 30 that were bilateral. Ureteral occlusion was successful in 35 of 37 renal units (94.6%) as determined by post-procedure antegrade nephrostogram and resolution of clinical symptoms of hematuria and/or urinary leakage. Repeat occlusion was necessary to achieve total ureteral occlusion in 2 of 35 renal units (5.7%).
Conclusions:
Percutaneous ureteral occlusion with platinum coils and Gelfoam offers a treatment option for patients with refractory urinary fistula and intractable hematuria in whom standard methods of urinary diversion fail.
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