TRUE FIT (Trans Renal Ureteral Embolization for Fistulae and Internal Tracts): A Single-Center Retrospective Cohort Study

Monday, March 6, 2023

12:00 PM – 1:00 PM

Location: Phoenix Convention Center, North Ballroom 120 D

Poster Presenter(s)

NS

Nathan Sim, BS (he/him/his)

Medical Student
Wayne State University School of Medicine

Disclosure(s): No financial relationships to disclose

Author/Co-author(s)

AM

Arif Musa, MD, M.S.

Chief Transitional Year Resident
ProMedica Monroe Regional Hospital
Hussam Hindi, DO

Resident Physician
Wayne State University/DMC
AA

Abdullah Ahmadou, MD

Resident Physician
Wayne State University/DMC
AH

Ali Harb, MD

Physician
Wayne State University/DMC

Disclosure(s):

Nathan Sim, BS: No financial relationships to disclose

Arif Musa, MD, M.S.: No relevant disclosure to display

Hussam Hindi, DO: No financial relationships to disclose

Purpose: Of patients that are diagnosed with radiation cystitis, malignancy, or other conditions, there is a risk of developing pathological internal tracts such as urinary tract fistulae. Despite urinary diversion with nephrostomy tubes, many patients have persistent urine leakage, increasing the risk of skin irritation, poor wound healing, and recurrent infections. Currently, there is no standard of care for the treatment of persistent urine leakage in these patients. However, one possible treatment is ureteral embolization. This study was performed to analyze the effectiveness of methods of ureteral embolization in patients with urinary tract fistulae.

Materials and Methods:

This was a single-center, retrospective cohort study of patients with urinary tract fistulae that underwent ureteral embolization from 2011 to 2022. Patient age, gender, technical success, total time under fluoroscopy, sedation or anesthesia, embolization method, intra-procedural complications, post-procedural complications, recurrent urinary leakage rates, re-embolization rates, and cost of materials were collected.

Results:

A total of 10 patients met inclusion criteria. The average age was 66.8 years and mostly female (70%). Technical success was achieved in 94.7% of embolizations. The total time under fluoroscopy was 23.5 ± 16.1 minutes. General anesthesia was used in 80% of patients (n = 8). Embolization methods included coils in 80% (n = 8), vascular plugs in 60% (n = 6), and n-butyl cyanoacrylate glue in 30% of patients (n = 3). There were no intra-procedural complications. In the post-procedural period, persistent urinary leakage was identified in 40% of patients (40%). Repeat embolization was done in 30% of patients (n = 3). The average cost of embolizing a single ureter was $3,404.18 (range: $374.70 to $9,335.00). The total cost, including re-embolizations, was $6,132.03 ± $5,632.29.

Conclusion:

Ureteral embolization with coils, n-butyl cyanoacrylate glue, and/or vascular plugs were used as single-agent or combination therapy for urinary leakage in patients with urinary tract fistulae. Though technical success rates were high, persistent urinary leakage occurred in nearly half of patients, and 30% required re-embolization. The cost of embolization was considerable and demonstrated substantial variability. Using multiple embolization materials appeared to be more effective than single embolization methods. Future high-quality randomized controlled trials are needed to determine the optimal method to embolize the ureter in patients with persistent urine leakage from urinary tract fistulae.