Minimally invasive radiologic techniques in the treatment of uretero-enteric fistulas

Abstract Objectives The goal of this study was to assess the efficacy of minimally invasive interventional radiologic (IR) techniques in the management of uretero-enteric fistulae in comparison to established surgical modalities. Materials and methods Twenty-five patients (16 men, 9 women) with a mean age of 47 (range: 19–77 years) with uretero-enteric fistulae were treated with percutaneous nephrostomy, double “J” stent, radiologic uretero-neocystostomy, and radiologic uretero-pyelocalicostomy. All patients had a single fistula each. Uretero-enteric fistulas were due to direct or iatrogenic trauma in 14 patients (uretero-ileal fistulas, n = 6; uretero-colonic fistulas, n = 4; uretero-duodenal fistulas, n = 2; uretero-pancreatic fistula, n = 1; uretero-fallopian tube, n = 1), complications of pelvic neoplasms in 4 patients (uretero-sigmoid fistulas, n = 4), inflammatory disease in 4 patients (uretero-ileal fistulas, n = 2; uretero-sigmoid fistulas, n = 2), and avascular necrosis of renal transplants in 3 patients (uretero-sigmoid fistulas, n = 3). Results Drainage by percutaneous nephrostomy and double “J” stent resulted in closure of 8 uretero-enteric fistulae over 7–16 weeks. Four uretero-enteric fistulae obliterated after re-routing urine flow using 3 radiologic uretero-neocystostomies and one IR pyelocalicostomy. In other patients, flow through the fistulae was substantially decreased by five double “J” stents and 3 percutaneous nephrostomies. The duration of inpatient hospitalization was significantly less for patients managed successfully by IR procedures than those treated by surgical modalities, 5.07 versus 10.5 days mean ( P < 0.05). Conclusions IR procedures provided definitive treatment in 48% of uretero-enteric fistulae at significantly reduced inpatient hospitalization and cost. As palliative treatment, it improved the quality of life.