E2380. Trans Renal Ureteral Embolization for Fistulae and Internal Tracts (TRUE FIT): A Retrospective Cohort Study
  1. Hussam Hindi; Detroit Medical Center/Wayne State University School of Medicine
  2. Abdullah Ahmadou; Detroit Medical Center/Wayne State University School of Medicine
  3. Nathan Sim; Detroit Medical Center/Wayne State University School of Medicine
  4. Arif Musa; Detroit Medical Center/Wayne State University School of Medicine; ProMedica Monroe Regional Hospital
  5. Ali Harb; Detroit Medical Center/Wayne State University School of Medicine
Patients with urinary tract fistula and leakage experience pain and decreased quality of life while facing risks of further complications including recurrent infections, skin irritation, and poor wound healing. Despite urinary diversion via percutaneous nephrostomy tubes, there is no standardized treatment for patients with continued urinary leakage. This study was performed to analyze ureteral embolization techniques for the treatment of urinary tract fistulas.

Materials and Methods:
An IRB approved retrospective cohort study of 9 patients who underwent 17 unilateral or bilateral ureteral embolizations from 2011 to 2022 was performed. Age, gender, technical success, time under fluoroscopy, total procedure time, sedation or anesthesia, embolization method, length of stay, intra-procedural complications, post-procedural complications, recurrent urinary leakage rates, and re-embolization rates were collected.

Of the 9 patients, the average age was 65.8 years and 66.6% were women. The technical success rate was 94.4%. Time under fluoroscopy was 23.8 ± 16.1 minutes, and total procedural time was 141.2 ± 55.5 minutes. Conscious sedation was used in 7 patients (77.8%), and the remaining patients were given general anesthesia. Embolization materials included coils in 8 patients (88.9%), vascular plugs in 5 patients (55.6%), and glue (n-butyl cyanoacrylate) in 2 patients (22.2%). Same-day discharge occurred in 3 cases (33.3%). There were no intra-procedural complications or fluoroscopic evidence of bladder opacification after embolization. However, urinary leakage continued postoperatively in 4 patients (44.4%), 3 (33.3%) of which underwent repeat embolization without complication. The embolization method with the highest success was a combination method including coils, whereas the single method embolization with vascular plugs had the lowest success rate.

Embolization coils, plugs, glue, and other embolization methods were used as single agents or in combination to embolize the ureter with coils being the most employed embolization agent. The rate of technical success was high, although urinary leakage continued in a significant number of patients. This study will aid in establishing larger clinical trials comparing the efficacy of different occlusion methods and the development of superior techniques in the future.