Transrenal Antegrade Ureteral Occlusion: Clinical Assessment of Indications, Technique and Outcomes.

Purpose: We describe the indications, technique and outcome of transrenal antegrade ureteral occlusion.

Materials And Methods: An institutional database was used to retrospectively identify patients who underwent image guided transrenal ureteral occlusion between December 1998 and March 2014. Platinum coils were deployed into the distal ureter or 4 to 5 cm proximal to the site of ureteral leak. Gelfoam® pledgets were injected in the ureter at the level of the coils. Additional coils were deployed to trap the pledgets in the distal ureter.

Results: Between December 1998 and March 2014, 12 men and 12 women with a mean age of 69 years (range 45 to 87) underwent fluoroscopically guided, transrenal antegrade ureteral occlusion for intractable hematuria in 7 and urinary fistula in 17. A total of 39 ureteral units were occluded, including 3 on the right side, 6 on the left side and 30 that were bilateral. Ureteral occlusion was successful in 35 of 37 renal units (94.6%) as determined by post-procedure antegrade nephrostogram and resolution of clinical symptoms of hematuria and/or urinary leakage. Repeat occlusion was necessary to achieve total ureteral occlusion in 2 of 35 renal units (5.7%).

Conclusions: Percutaneous ureteral occlusion with platinum coils and Gelfoam offers a treatment option for patients with refractory urinary fistula and intractable hematuria in whom standard methods of urinary diversion fail.