Rofo 2018; 190(08): 692-700
DOI: 10.1055/a-0581-5533
Review
© Georg Thieme Verlag KG Stuttgart · New York

Percutaneous Treatment Options of Lower Urinary Tract Fistulas and Leakages

Perkutane Therapieoptionen von Fisteln und Leckagen der ableitenden Harnwege
Daniel Kuetting
Department of Radiology, University Hospital, Bonn, Germany
Department of Radiology, University Hospital, Bonn, Germany
,
Claus Christian Pieper
Department of Radiology, University Hospital, Bonn, Germany
Department of Radiology, University Hospital, Bonn, Germany
› Institutsangaben
Weitere Informationen

Publikationsverlauf

07. Dezember 2017

15. Februar 2018

Publikationsdatum:
25. Juli 2018 (online)

Widmung

Diese Arbeit ist Herrn Univ.-Prof. Dr. med. Hans Heinz Schild gewidmet, bei dem wir uns herzlich für die langjährige und stete Unterstützung in allen klinischen und wissenschaftlichen Belangen bedanken möchten.

Abstract

Background 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.

Method 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.

Results and Conclusion 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.

Key Points

  • 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.

Citation Format

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

Zusammenfassung

Hintergrund Fisteln des unteren Harntrakts sind seltene Erkrankungen die häufig mit einer beträchtlichen Morbidität einhergehen. Die Behandlung solcher Fisteln oder Leckagen ist technisch anspruchsvoll und stellt eine interdisziplinäre Herausforderung dar. Insbesondere bei Fisteln, die durch Tumoren verursacht werden oder nach Strahlentherapie auftreten ist die Erfolgsquote chirurgischer Verfahren limitiert. Des Weitern schließen schwere Komorbiditäten in diesem Patientengut häufig operative Eingriffe aus, sodass alternativ perkutane Behandlungsansätze als weniger invasive Behandlungsoption in Frage kommen.

Methode Diese Übersicht basiert auf Fallserien und Fallberichten zur perkutanen Behandlung von Fisteln und Leckagen des unteren Harntrakts aus den letzten vier Jahrzehnten (1979 – 2017). Berücksichtigte Methoden waren dabei Ureterfulguration, Gewebeklebstoff-basierte Embolisation, nicht-ablösbare und ablösbare Ballons, Ureterclipping, Uretercoiling, Silikon und Nylon Plugs sowie modifizierte Vascular Plugs.

Ergebnisse und Schlussfolgerung Perkutane Behandlungsmöglichkeiten von Fisteln und Leckagen des unteren Harntrakts ermöglichen eine entweder temporäre oder dauerhafte, instantane Ureterokklusion. Die transrenale Ureterokklusion ist im Allgemeinen eine sichere und zuverlässige Alternative zur operativen Sanierung von Ureterfisteln und -leckagen. Bisher hat sich keine Technik als überlegen erwiesen. Abhängig von der zugrundeliegenden Erkrankung kann die optimale Therapieoption variieren. Die Therapie sollte den individuellen Bedürfnissen der Patienten entsprechend angepasst werden.

Kernaussagen

  • Patienten mit therapierefraktären Ureterfisteln/Ureterleckagen können von der transrenalen Ureterokklusion profitieren.

  • Die transrenale Ureterokklusion ermöglicht langfristige Symptomlinderung.

  • Interventionelle Radiologen sollten mit den gängigen Techniken der transrenalen Ureterokklusion vertraut sein.

 
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