Percutaneous embolization of contained iatrogenic vesicourethral fistula using Amplatzer vascular plug and N-butyl-2-cyanoacrylate: a case report

Abstract

Purpose: Reports on percutaneous embolization of vesicourethral anastomotic fistula are limited.

Case presentation: A 59-year-old male presented with persistent contained vesicourethral fistula following low anterior resection and radical retropubic prostectomy for rectal cancer. A contained fistula with urinary leakage of 350 ml/day through a Jackson-Pratt (JP) tube was found at the posterior aspect of the vesicourethral anastomotic site on cystography. After 1 month of failed conventional urinary drainage manoeuvre, percutaneous embolization of the contained fistula was successfully performed through the JP tube. An Amplatzer vascular plug (AVP) was used to block the fistula and N-butyl-2-cyanoacrylate (NBCA) was used to obliterate the urinoma cavity. Computed tomography scans at 1-month and 1-year follow-ups showed stable AVP position and complete obliteration of the cavity by NBCA.

Conclusions: The contained vesicourethral anastomotic fistula was successfully managed with AVP and NBCA via a JP drainage tube. It is expected that AVP will block the fistula and NBCA will obliterate the urinoma cavity effectively.

Keywords: therapeutic embolization; urinary bladder; urinary fistula.