LONG-TERM RESULTS OF TRANSRENAL URETERAL OCCLUSION WITH USE OF GIANTURCO COILS AND GELATIN SPONGE PLEDGETS

PURPOSE: To evaluate transrenal ureteral occlusion with Gianturco coil s and gelatin sponge pledgets. MATERIALS AND METHODS: The authors revi ewed 34 ureteral occlusions in 22 patients during a 4-year period. The indications for this procedure included vesicovasnal fistula in 11 pa tients and urinary incontinence in three patients. All patients except one had a history of pelvic malignancy and previous radiation therapy . Pre-existing percutaneous nephrostomy tubes were in place in 20 uret ers to be embolized. Distal ureteral occlusion was achieved by placeme nt of Gianturco coils alone or in combination with gelatin sponge pled gets. A percutaneous nephrostomy catheter was then placed to provide p ermanent external diversion. Follow-up ranged from 2 weeks to 29 month s (mean, 6.2 months). RESULTS: Occlusion was technically successful in all embolized ureters. All patients experienced prompt resolution of symptoms as indicated by complete or near complete perineal dryness wi thin 72 hours. Complications were limited to coil migration into the r enal pelvis in two patients and nephrostomy catheter occlusion requiri ng replacement in another three patients. CONCLUSION: Ureteral occlusi on with Gianturco coils and gelatin sponge is a safe and reliable meth od of achieving permanent supravesical urinary diversion in the manage ment of chronic lower urinary tract fistulas.