Email updates

Keep up to date with the latest news and content from BMC Urology and BioMed Central.

Open Access Case report

Minimally invasive treatment of urinary fistulas using N-butyl-2-cyanoacrylate: a valid first line option

Cesare Selli12*, Maurizio De Maria1, Michele Manica1, Filippo Maria Turri1 and Francesca Manassero1

Author Affiliations

1 Department of Urology, University of Pisa, Pisa, Italy

2 Urologia Universitaria, Edificio 30 C, via Paradisa 2, Pisa, I-56124, Italy

For all author emails, please log on.

BMC Urology 2013, 13:55  doi:10.1186/1471-2490-13-55

Published: 24 October 2013

Abstract

Background

A few single case reports and only one clinical series have been published so far about the use of N-butyl-2-cyanoacrylate in the treatment of urinary fistulas persisting after conventional urinary drainage.

Case presentation

We treated five patients with a mean age of 59.2 years presenting iatrogenic urinary fistulas which persisted following conventional drainage manouvres. There were 3 calyceal fistulas following open, laparoscopic and robotic removal of renal lesions respectively, one pelvic fistula after orthotopic ileal neobladder and a bilateral dehiscence of uretero-sigmoidostomy. We used open-end catheters of different sizes adopting a retrograde endoscopic approach for cyanoacrylate injection in the renal calyces, while a descending percutaneous approach via the pelvic drain tract and bilateral nephrostomies respectively was used for the pelvic fistulas. Fluoroscopic control was always used during the occlusion procedures. The amount of adhesive injected ranged between 2 and 5 cc and in one case the procedure was repeated. With a median follow-up of 11 months we observed clinical and radiological resolution in 4 cases (80%), while a recurrent and infected calyceal fistula after laparoscopic thermal renal damage during tumor enucleoresection required nephrectomy. No significant complications were documented.

Conclusions

In an attempt to spare further challenging surgery in patients that had been already operated on recently, minimally invasive occlusion of persistent urinary fistulas with N-butyl-2-cyanoacrylate represents a valid first line treatment, justified in cases when the urinary output is not excessive and there is a favorable ratio between the length and diameter of the fistulous tract.

Keywords:
Urinary fistulas; N-butyl-2-cyanoacrylate