Percutaneous Treatment Options of Lower Urinary Tract Fistulas and Leakages

Lower urinary tract fistulas are currently a rather rare, but severe condition associated with considerable morbidity. Treatment is challenging, especially in fistulas caused by pelvic malignancy or radiation therapy. Surgical treatment attempts fail in a considerable number of patients, especially in those with pelvic malignancies/prior radiation therapy or are precluded altogether due to severe comorbidity. For such patients percutaneous approaches can provide alternative treatment.

This review is based on case studies and case reports dealing with percutaneous treatment options of lower urinary tract fistulas and leakages from the past four decades (1979 - 2017). The included techniques were ureteral fulguration, tissue adhesive-based embolization, non-detachable and detachable balloon occlusion, ureteral coiling, ureteral clipping, silicone or nylon plug as well as modified vascular plug embolization.

Percutaneous treatment options of lower urinary tract fistulas and leakages allow for either permanent or temporary, instant ureteral occlusion. In general, transrenal ureteral occlusion is a safe and reliable alternative to surgical treatment of ureteral fistulas and leakages. So far, no technique has been proven to be superior to the others. Depending on the underlying disease, the optimal percutaneous technique may vary and should be chosen according to the individual needs of the patients.

· Patients with therapy-refractory urerteral fistulas may benefit from transrenal ureteral occlusion.. · Transrenal ureteral occlusion allows for long-term symptom relief.. · Ureteral occlusion should be in the armamentarium of interventional radiologists..

· Kuetting D, Pieper CC . Percutaneous Treatment Options of Lower Urinary Tract Fistulas and Leakages. Fortschr Röntgenstr 2018; 190: 692 - 700.