13th Annual Global Embolization Symposium & Technologies
Purpose : The purpose of this study was to achieve complete urinary diversion in a patient using an endoluminal device to permanently occlude (embolize) both distal ureters.
Material and Methods : The EOS is a device with a self-expanding spring-like core of nitinol covered with an ultra-thin membrane of nonporous PTFE (poly tetra fluoro ethylene). It has been previously applied in arterial and venous embolization procedures.
The patient is a 62 year old female was found to have a pelvic mass which was subsequently biopsied. She was given a diagnosis of advanced cervical carcinoma and post treatment developed complex pelvic fistulae requiring urinary diversion.
She represented complaining of persistent malodorous fluid draining from her vagina and associated with loose bowel movements. A CT scan showed a recurrent pelvic mass and vesico-vaginal and vesico-rectal fistulae. She had no further treatment options. For palliation, a decision was made to attempt complete and durable minimally-invasive bilateral distal ureteral occlusion.
Informed consent was obtained. In each distal ureter (proximal to the uterovesicular junction and caudal to the tortuous fibrosed/encased ureter) a single 8mm in diameter EOS device was deployed. Immediate post deployment contrast injection confirmed complete distal ureteral occlusion. The nephrostomy tubes and urine drainage bags were replaced to allow for complete urinary diversion.
Results : Final bilateral nephrostograms and nephrostomy tube exchanges were performed 15 days later. The ureters remained occluded with no contrast seen in the bladder. Because of persistent rectal discharge; now felt to be due to radiation enteritis, she underwent surgery for a diverting colostomy.
Conclusions : Percutaneous occlusion of the ureters has been described using coils, various types of “plugs” and tissue adhesives. Not infrequently, the occlusion is brief.
Although a limitation of this case report is its lack of long term follow-up, this case documents the application of a commercially available device that is percutaneously deployed, minimally invasive, and has the potential to enhance the quality of life in select patients. To the best of our knowledge, this is the first clinical application of the device used to successfully occlude ureters in the United States.