Purpose:
Ureteric fistulae after gynecological surgery are a typical postoperative (PO) complication.
In the past, fistula detection was performed by X-Ray or CT. The aim of this study
is to show that ultrasound using the novel „Pumping Probe Technique“ (PPT) is an alternative
method of detecting fistulae. A new intermural complete sealing ureteric stent prevents
leakage, covers the tissue and allows the tissue to heal without further measures.
Methods:
In 59 cases between June 2012 to February 2017 we used the new PPT in both endoluminal
sonography and elastography to visualize ureteric fistulae. The technique involves
the forward and backward movement of an ultrasound probe to generate pressure in the
fistula, thus leading to a movement of the fluid within so that it can be detected.
We found 34 ureterico-vaginal fistulae, 10 ureteric-douglas fistulae, 12 ureteric-enteric
fistulae and 3 arterio-ureteric fistula using this method. Each patient was then treated
with the implantation of a self-expanding covered stent.
Results:
A fistula was detected by elastography in only 44 of the cases, however using ultrasound
52 of 59 were visualized, both imaging modalities were performed with the new PPT.
X-Ray and CT were then used to confirm the diagnosis. In 54 of the 59 cases the fistula
was successfully closed.
Conclusions:
Endoluminal sonography and elastography using the novel PPT detected approximately
91% of the fistula cases. The subsequent management of ureteric fistulae with stents
can be performed gently, safely and quickly. The cure rate was high at 91%.
