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

Autor: Lang EK; Department Radiology, Tulane School of Medicine, New Orleans, LA, United States; Johns Hopkins Medical Institutions, 600, North Wolfe Street, Baltimore, MD 21205, United States; Tulane University Hospital, 1415, Tulane Avenue, New Orleans, LA 70112, United States., Allaei A; Department of Radiology, State University of New York Downstate Medical Center, 451, Clarkson Avenue, Brooklyn, NY 11203, United States. Electronic address: aallaei@gmail.com., Robinson L; Department of Radiology, State University of New York Downstate Medical Center, 451, Clarkson Avenue, Brooklyn, NY 11203, United States., Reid J; Department of Radiology, State University of New York Downstate Medical Center, 451, Clarkson Avenue, Brooklyn, NY 11203, United States., Zinn H; Department of Radiology, State University of New York Downstate Medical Center, 451, Clarkson Avenue, Brooklyn, NY 11203, United States.
Jazyk: angličtina
Zdroj: Diagnostic and interventional imaging [Diagn Interv Imaging] 2015 Nov; Vol. 96 (11), pp. 1153-60. Date of Electronic Publication: 2015 Jul 07.
DOI: 10.1016/j.diii.2015.06.010
Abstrakt: 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.
(Copyright © 2015 Éditions françaises de radiologie. Published by Elsevier Masson SAS. All rights reserved.)
Databáze: MEDLINE
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