Federico Fontana1,2, Filippo Piacentino1,2, Christian Ossola2, Jvan Casarin2,3, Andrea Coppola1, Antonella Cromi2,3, Anna Maria Ierardi4, Gianpaolo Carrafiello4,5, Antonio Basile6, Federico Deho7, Fabio Ghezzi2,3, Giulio Carcano2,8, Massimo Venturini1,2. 1. Diagnostic and Interventional Radiology Department, Ospedale Di Circolo, ASST dei Sette Laghi, 21100 Varese, Italy. 2. School of Medicine and Surgery, Università degli Studi dell'Insubria, 21100 Varese, Italy. 3. Obstetrics and Gynecology Department, Ospedale "Filippo Del Ponte", ASST dei Sette Laghi, 21100 Varese, Italy. 4. Diagnostic and Interventional Radiology Department, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy. 5. Department of Radiology and Department of Health Sciences, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico and University of Milano, 20122 Milan, Italy. 6. Radiology Unit I, Department of Medical Surgical Sciences and Advanced Technologies, University Hospital "Policlinico-Vittorio Emanuele", 95123 Catania, Italy. 7. Urology Department, Ospedale Di Circolo, ASST dei Sette Laghi, 21100 Varese, Italy. 8. Surgery Department, Ospedale di Circolo, ASST dei Sette Laghi, 21100 Varese, Italy.
Abstract
OBJECTIVE: To report safety and efficacy of interventional radiology procedures in the treatment of gynecologic iatrogenic urinary leaks. METHODS: A retrospective analysis of iatrogenic ureteral lesions treated between November 2009 to April 2019 was performed. Under ultrasound (US) and fluoroscopy guidance, an attempt to place a ureteral stent and nephrostomy was carried out in the same session using an anterograde percutaneous approach. At the end of any procedure, a fluoroscopic control and a cone-beam CT scan (CBCT) were performed to check the correct placement and functioning of the nephrostomy and DJ stent. In cases of difficult ureteral stent placement via the single anterograde approach, the collaboration of urologists was requested to perform a rendezvous technique, combined with the retrograde approach. RESULTS: DJ stent placement was achieved using the anterograde approach in 12/15 (80.0%) patients and using the retrograde approach in 3/15 cases (20.0%). Moreover, in 3/15 (20.0%) patients, surgical treatment was needed: in one case because of the persistence of ureteral stenosis at 6 months, and in the other two cases due to ureter-vaginal fistula. No major complications were recorded; overall, minor complications occurred in 4/8 patients. CONCLUSION: Percutaneous minimally invasive treatment of iatrogenic ureteral lesions after gynecological surgery is a safe and effective option.
OBJECTIVE: To report safety and efficacy of interventional radiology procedures in the treatment of gynecologic iatrogenic urinary leaks. METHODS: A retrospective analysis of iatrogenic ureteral lesions treated between November 2009 to April 2019 was performed. Under ultrasound (US) and fluoroscopy guidance, an attempt to place a ureteral stent and nephrostomy was carried out in the same session using an anterograde percutaneous approach. At the end of any procedure, a fluoroscopic control and a cone-beam CT scan (CBCT) were performed to check the correct placement and functioning of the nephrostomy and DJ stent. In cases of difficult ureteral stent placement via the single anterograde approach, the collaboration of urologists was requested to perform a rendezvous technique, combined with the retrograde approach. RESULTS: DJ stent placement was achieved using the anterograde approach in 12/15 (80.0%) patients and using the retrograde approach in 3/15 cases (20.0%). Moreover, in 3/15 (20.0%) patients, surgical treatment was needed: in one case because of the persistence of ureteral stenosis at 6 months, and in the other two cases due to ureter-vaginal fistula. No major complications were recorded; overall, minor complications occurred in 4/8 patients. CONCLUSION: Percutaneous minimally invasive treatment of iatrogenic ureteral lesions after gynecological surgery is a safe and effective option.
Authors: Dindi D Reddy; Riad Salem; Jose A Gonzalez; David Konstandt; Ziad Sergie; Robert Lewandowski Journal: J Vasc Interv Radiol Date: 2003-06 Impact factor: 3.464