Percutaneous Obliteration of Urinary Leakage after Partial Nephrectomy Using Coils and N-butyl-cyanoacrylate

Background: Urinary leakage is uniquely associated with partial nephrectomy (PN) and remains a challenging complication to treat. Recently, minimally invasive percutaneous approach to obliterate the urinary leakage after PN has been developed. Method(s): Data of 10 consecutive patients who underwent percutaneous obliteration of urinary leakage after PN using coil and NBCA were reviewed. A urinary fistulography was performed via the drainage catheter previously placed in the urinoma, and a pyelography was performed to locate the fistulous tract. If the fistulous tract was clearly visualized, super-selective embolization of the fistulous tract with coils and urinoma cavity sealing with NBCA were performed. In cases where the fistulous tract could not be clearly visualized, only urinoma cavity sealing was performed. Technical success was defined as complete occlusion of visualized urinary fistulous tract and followed urinoma cavity sealing. Clinical success was defined as control of current urinary leakage and either disappearance or decrease in size of the urinoma on follow-up computed tomography (CT). Result(s): In seven (70%) patients who showed obvious urinary fistulous tract, coil embolization of urinary fistulous tract and followed by sealing of urinoma cavity with NBCA was performed. Only sealing of urinoma cavity with NBCA was performed in three patients (30%) who could not visualize the distinct fistulous tract. All of the patients showed gradually decrease in size or complete disappearance of urinoma on follow-up CT without further symptom and sign of urinary leakage during the follow-up period (mean, 44.6 weeks; range, 11-117 weeks). Conclusion(s): Percutaneous obliteration of urinary leakage after PN using coils and NBCA is safe and effective. On the basis of the urinary fistulography, assessed by drainage catheter in the urinoma and pyelography, super-selective embolization of fistulous tract with coil and followed sealing of urinoma cavity with NBCA or only sealing of urinoma cavity offer complete occlusion of the urinary leakage.

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Artikel online veröffentlicht:
11. Mai 2021