Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2011 Dec;28(4):392-5.
doi: 10.1055/s-0031-1296081.

Ureteral interventions

Radha Popuri  1 , Darryl A Zuckerman
Affiliations

Ureteral interventions

Radha Popuri et al. Semin Intervent Radiol. 2011 Dec.

Abstract

The pelvic course of the ureter with its close proximity to the iliac artery, pelvic viscera, and other structures predispose to fistula formation. Surgical management of lower urinary tract fistulas is difficult and often ineffective. Nonvascular lower urinary tract fistulas can be managed by urinary diversion with percutaneous nephrostomy to allow for fistula healing. If this fails, ureteral embolization can be very effective; however, this should be preceded by careful evaluation and discussion with the patient as this intervention results in irreversible ureteral occlusion necessitating a diverting nephrostomy catheter indefinitely. A ureteroarterial fistula is a distinct entity compared with nonvascular fistulas with a different approach to management; it can be managed by exclusion of the fistula by endovascular placement of a stent graft across the arterial component of the fistula.

Keywords: Fistula; embolization; kidney; nephrostomy; ureter.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Vaginal contrast injection reveals fistula to bladder.
Figure 2
Figure 2
Bilateral nephrostograms delineating the course of the ureters.
Figure 3
Figure 3
Postbilateral ureteral embolization with coils and Gelfoam. Contrast columns are seen in the proximal ureters.
Figure 4
Figure 4
Percutaneous retrieval of an occluded double-J ureteral stent was performed in a female patient at the time of nephrostomy insertion. Pulsatile blood flow can be seen from the nephrostomy access after stent retrieval. A clot in the collecting system is also shown.
Figure 5
Figure 5
Contrast injection through a catheter advanced into the ureter shows filling of the left iliac arteries with fistula to the common iliac artery (arrow).
Figure 6
Figure 6
The ipsilateral internal iliac artery was embolized to prevent an endoleak around the stent graft from retrograde flow.
Figure 7
Figure 7
Angiogram poststent-graft placement (black arrow) showing complete exclusion of the fistula with no residual filling of the ureter. An access wire through the ureter is shown (white arrow).
See this image and copyright information in PMC

References

    1. Avritscher R, Madoff D C, Ramirez P T, et al. Fistulas of the lower urinary tract: Percutaneous approaches for the management of a difficult clinical entity. Radiographics. 2004;24(suppl 1):S217–S236. - PubMed
    1. Bing K T, Hicks M E, Figenshau R S, et al. Percutaneous ureteral occlusion with use of Gianturco coils and gelatin sponge. Part I. Swine model. J Vasc Interv Radiol. 1992a;3(2):313–317. - PubMed
    1. Bing K T, Hicks M E, Picus D, Darcy M D. Percutaneous ureteral occlusion with use of Gianturco coils and gelatin sponge. Part II. Clinical experience. J Vasc Interv Radiol. 1992;3(2):319–321. - PubMed
    1. Shindel A W, Zhu H, Hovsepian D M, Brandes S B. Ureteric embolization with stainless-steel coils for managing refractory lower urinary tract fistula: a 12-year experience. BJU Int. 2007;99(2):364–368. - PubMed
    1. Adamo R, Saad WEA, Brown D B. Percutaneous ureteral interventions. Tech Vasc Interv Radiol. 2009;12(3):205–215. - PubMed