International Urogynecology Journal

, Volume 30, Issue 2, pp 287–292 | Cite as

Management of urinary-tract fistulas using reversible balloon nephrostomy: a single-center retrospective analysis of 56 patients

  • Jérôme GasEmail author
  • François-Xavier Nouhaud
  • Mathieu Roumiguié
  • Séverine Lagarde
  • Marie-Charlotte Delchier
  • Éric Huyghe
  • Michel Soulié
  • Xavier Gamé
  • Jean-Baptiste Beauval
Original Article



To evaluate the effectiveness of balloon nephrostomy (BN) for treating urinary tract fistulas.

Materials and methods

In a single-center retrospective analysis, 56 patients were treated using BN between 2003 and 2014. All causes of urinary tract fistula were included. We assessed the effectiveness of drainage, complications, and the types of reconstruction surgery used. Success was defined as fistula closure without surgery.


The cohort consisted of 25 males (54%) and 31 females (55%) with a median age of 63 years who underwent BN for a urinary fistula secondary to surgery, i.e., urologic (40%; n = 22), gynecologic (34%; n = 19), or digestive (20%; n = 11). Of these patients, 48 (86%) had a history of cancer (49% had a tumor progression). Median drainage time was 90 days (10–583), with an average of three successive readjustments needed per patient. We obtained a 21% success rate (n = 12), morbidity was 6.5% (urinary sepsis, renal abscess, ureteral stricture), and 7% of patients developed ureteral stricture after balloon removal. There was no recurrence of any fistula within a median follow-up time of 15.2 months.


This minimally invasive procedure can be used for selected urinary tract fistulas with few complications. It can also be used safely in populations that have several comorbidities.


Iatrogenic Percutaneous treatment Surgery Urinary fistula Unfit population 


Compliance with ethical standards

Conflicts of interest


Ethical standards

The patients’ characteristics and treatment strategies were collected by screening medical records after approval from our Institutional Review Board.


  1. 1.
    Lynch TH, Martinez-Pineiro L, Plas E, Serafetinides E, Turkeri L, Santucci RA, et al. EAU guidelines on urological trauma. Eur Urol. 2005;47(1):1–15.CrossRefGoogle Scholar
  2. 2.
    Flores-Carreras O, Cabrera JR, Galeano PA, Torres FE. Fistulas of the urinary tract in gynecologic and obstetric surgery. Int Urogynecol J Pelvic Floor Dysfunct. 2001;12(3):203–14.CrossRefGoogle Scholar
  3. 3.
    Hennessey DB, Bolton E, Thomas AZ, Lynch TH (2013) Vesicocutaneous fistula following adjuvant radiotherapy for prostate cancer. BMJ Case reports.
  4. 4.
    Bryk DJ, Zhao LC (2015) Guideline of guidelines: A review of urologic trauma guidelines. BJU Int.Google Scholar
  5. 5.
    Aristide Kabore F, Kambou T, Ouattara A, Zango B, Yameogo C, Kirakoya B, et al. Epidemiology, etiology and psychosocial impact of urogenital fistulas in a cohort of 170 consecutive patients managed in three treatment centers in Burkina Faso from 2010 to 2012. Prog Urol. 2014;24(8):526–32.CrossRefGoogle Scholar
  6. 6.
    Obarisiagbon EO, Olagbuji BN, Onuora VC, Oguike TC, Ande AB. Iatrogenic urological injuries complicating obstetric and gynaecological procedures. Singap Med J. 2011;52(10):738–41.Google Scholar
  7. 7.
    Koukouras D, Petsas T, Liatsikos E, Kallidonis P, Sdralis EK, Adonakis G, et al. Percutaneous minimally invasive management of iatrogenic ureteral injuries. J Endourol/Endourol Soc. 2010;24(12):1921–7.CrossRefGoogle Scholar
  8. 8.
    Msezane L, Reynolds WS, Mhapsekar R, Gerber G, Steinberg G. Open surgical repair of ureteral strictures and fistulas following radical cystectomy and urinary diversion. J Urol. 2008;179(4):1428–31.CrossRefGoogle Scholar
  9. 9.
    Avritscher R, Madoff DC, Ramirez PT, Wallace MJ, Ahrar K, Morello FA Jr, et al. Fistulas of the lower urinary tract: percutaneous approaches for the management of a difficult clinical entity. Radiographics. 2004;24(Suppl 1):S217–36.CrossRefGoogle Scholar
  10. 10.
    Gunther RW, Klose KJ, Alken P, Bohl J. Transrenal ureteral occlusion using a detachable balloon. Urol Radiol. 1984;6(3-4):210–4.CrossRefGoogle Scholar
  11. 11.
    Horenblas S, Kroger R, van Boven E, Meinhardt W, Newling DW. Use of balloon catheters for ureteral occlusion in urinary leakage. Eur Urol. 2000;38(5):613–7.CrossRefGoogle Scholar
  12. 12.
    Zairi A, Nohra J, Khedis M, Thoulouzan M, Otal P, Joffre F, et al. Results of balloon nephrostomy in the treatment of lower urinary tract fistula. Prog Urol: J Assoc Fr Urol Soc Fr Urol. 2008;18(6):372–8.CrossRefGoogle Scholar
  13. 13.
    Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240(2):205–13.CrossRefGoogle Scholar
  14. 14.
    De Ridder D. An update on surgery for vesicovaginal and urethrovaginal fistulae. Curr Opin Urol. 2011;21(4):297–300.CrossRefGoogle Scholar
  15. 15.
    Burks FN, Santucci RA. Management of iatrogenic ureteral injury. Ther Adv Urol. 2014;6(3):115–24.CrossRefGoogle Scholar
  16. 16.
    Al-Otaibi KM. Ureterovaginal fistulas: the role of endoscopy and a percutaneous approach. Urol Ann. 2012;4(2):102–5.CrossRefGoogle Scholar
  17. 17.
    Franke M, Winand S, Chang DH, Wille S, Maintz D, Bangard C. Urinary tract fistulas: Transrenal reversible ureteral occlusion with detachable Semicompliant balloons. Urology. 2015;86(2):388–93.CrossRefGoogle Scholar
  18. 18.
    Oakley SH, Brown HW, Greer JA, Richardson ML, Adelowo A, Yurteri-Kaplan L, et al. Management of vesicovaginal fistulae: a multicenter analysis from the Fellows’ pelvic research network. Female Pelvic Med Reconstr Surg. 2014;20(1):7–13.CrossRefGoogle Scholar
  19. 19.
    Papanicolaou N, Pfister RC, Yoder IC. Percutaneous occlusion of ureteral leaks and fistulae using nondetachable balloons. Urol Radiol. 1985;7(1):28–31.CrossRefGoogle Scholar
  20. 20.
    Li C, Liu Z, Yang F. Predictors of catheter-related bladder discomfort after urological surgery. J Huazhong Univ Sci Technol Med Sci. 2014;34(4):559–62.CrossRefGoogle Scholar
  21. 21.
    Waaldijk K. The immediate surgical management of fresh obstetric fistulas with catheter and/or early closure. Int J Gynaecol Obstet. 1994;45(1):11–6.CrossRefGoogle Scholar
  22. 22.
    Linder BJ, Umbreit EC, Larson D, Dozois EJ, Thapa P, Elliott DS. Effect of prior radiotherapy and ablative therapy on surgical outcomes for the treatment of rectourethral fistulas. J Urol. 2013;190(4):1287–91.CrossRefGoogle Scholar
  23. 23.
    Degirmenci T, Gunlusoy B, Kozacioglu Z, Arslan M, Ceylan Y, Ors B, et al. Utilization of a modified Clavien classification system in reporting complications after ultrasound-guided percutaneous nephrostomy tube placement: comparison to standard Society of Interventional Radiology practice guidelines. Urology. 2013;81(6):1161–7.CrossRefGoogle Scholar
  24. 24.
    Paluku JL, Carter TE. Obstetric vesico-vaginal fistulae seen in the northern Democratic Republic of Congo: a descriptive study. Afr Health Sci. 2015;15(4):1104–11.CrossRefGoogle Scholar

Copyright information

© The International Urogynecological Association 2018

Authors and Affiliations

  • Jérôme Gas
    • 1
    Email author
  • François-Xavier Nouhaud
    • 1
  • Mathieu Roumiguié
    • 1
  • Séverine Lagarde
    • 2
  • Marie-Charlotte Delchier
    • 2
  • Éric Huyghe
    • 1
  • Michel Soulié
    • 1
  • Xavier Gamé
    • 1
  • Jean-Baptiste Beauval
    • 1
  1. 1.Department of Urology, Andrology and Kidney TransplantationCHU ToulouseToulouseFrance
  2. 2.Department of RadiologyCHU ToulouseToulouseFrance

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