Endoscopic injection of fibrin glue for the treatment of urinary-tract pathology

Abstract

Background and purpose: Urinary-tract fistulas present unique clinical challenges that often necessitate open surgical excision with interposition of healthy tissue. Advances in retrograde instrumentation have enabled endourologists to employ more minimally invasive approaches to urologic disease, including fistulas. We reviewed our experience with endoscopic injection of fibrin glue for the treatment of urinary-tract pathology.

Patients and methods: We performed a retrospective review of the eight patients at our institution who have undergone retrograde endoscopic injection of fibrin glue for the treatment of urinary-tract pathology. The data collected included age, presentation, treatment technique, method/duration of follow-up, complications, and success, which was defined as subjective and objective resolution of the treated pathology.

Results: One of these patients was treated for a caliceal diverticulum refractory to percutaneous ablation. The other seven patients were treated for fistulas, including one colovesical fistula, two vesicovaginal fistulas, one ileal conduit-cutaneous fistula, one ureterocutaneous fistula, one urethrocutaneous fistula, and one ureterorectal fistula. All lesions except the urethrocutaneous fistula and the ureterorectal fistula were treated with a single injection of fibrin glue. At a mean follow-up of 11.75 months, this technique was successful in six cases (75%). Two (33%) of the successfully treated patients required two injections. There were no complications. Failures were apparent at initial follow-up.

Conclusion: Retrograde endoscopic injection of fibrin glue offers a novel approach to ablation of caliceal diverticula. Additionally, although open surgical excision of urinary-tract fistulae remains the gold standard treatment, endoscopic injection of fibrin glue offers a safe, minimally invasive approach that may avoid the morbidity of open surgery in such challenging patients.