Successful endoscopic management of a chronic transplant ureterocutaneous fistula.

OBJECTIVE

To illustrate a minimally invasive, well-tolerated, clinically, and cost-effective method for surgically managing a high-output, transplant ureterocutaneous fistula manifesting as chronic urinary tract infection and recurrent pyelonephritis. This method will subject the immunosuppressed patient to less morbidity and minimize risk to the functioning renal graft.

METHODS

A combined percutaneous-endoscopic fistula closure method was developed using Deflux® to cystoscopically occlude the transplant ureteral orifice and Bioglue® to seal the ureter and fistula tract.

RESULTS

The patient was infection free, completely dry, and had no voiding dysfunction after undergoing this occlusion method.

CONCLUSION

This report demonstrates that this minimally invasive technique is a safe, well-tolerated, and effective technique that may be offered as an outpatient, first-line therapy over open or laparoscopic excision.