Transrenal Ureteric Embolic Occlusion for Refractory Urinary Leakage and Fistulae: A Systematic Review and...

To evaluate the technical success, clinical success, safety, and re-intervention rates of ureteric embolic occlusion in patients with refractory urinary leakage or fistulae who were unsuitable for surgical management, and to summarise the available evidence regarding procedural durability and adverse events.

PubMed, EMBASE, and Cochrane CENTRAL were searched through 31 May 2026 for studies reporting outcomes of permanent ureteric embolic occlusion. Eligible studies underwent independent screening, data extraction, quality assessment, and meta-analysis. Pooled technical success, clinical success, and re-intervention rates were calculated using a random effects model with 95% confidence intervals.

Twelve retrospective studies involving 129 patients and 209 ureters were included. Pooled technical success was 100% (95% CI, 0.99-1.00), demonstrating near-universal immediate ureteric occlusion. Clinical success was 96% (95% CI, 0.87-1.00), although definitions of clinical response varied between studies. The overall re-intervention rate was 7.2% (95% CI, 0-0.09), reflecting repeat embolisation for recanalisation or persistent urinary leakage. No procedure-related mortality or major complications were reported. Adverse events were generally minor and included device migration, nephrostomy-related complications, urinary tract infections, and rare vascular complications.

Ureteric embolic occlusion provides excellent short-term technical and clinical outcomes with minimal morbidity and low re-intervention rates in carefully selected non-surgical patients. However, the available evidence is limited by small retrospective cohorts, heterogeneous outcome definitions, and limited long-term follow-up. Future prospective multicentre studies should standardise definitions of clinical success, assess long-term durability, report nephrostomy-associated morbidity and patient-reported outcomes, and directly compare different embolic techniques and materials used more comprehensively.