RESUMEN
PURPOSE: To describe outcomes of transrenal embolization with vascular plugs and ethylene vinyl alcohol (EVOH) in a case series of patients with refractory urinary leak or fistula. MATERIALS AND METHODS: Fifteen ureteral occlusions performed over 53 months in 9 consecutive patients (56% female; mean age 61 y; range, 45-80 y) were reviewed retrospectively. The main indication was palliation for refractory fistula or leak in the setting of malignancy not responding to urine diversion by percutaneous nephrostomy tube or nephroureteral stent. Transrenal ureteral occlusion was performed using EVOH injected between vascular plugs placed distal and proximal to the leak or fistula. RESULTS: Technical success was 100%. Considerable reduction of urine leak or symptoms (clinical success) was achieved in 64% of ureters after mean follow-up of 105 days (range, 0-632 d). Complete ureteral occlusion on follow-up anterograde nephrostogram (imaging success) was achieved in 60% of ureters after mean follow-up of 139 days (range, 0-643 d). One patient with distal ureterovesical junction-perineal fistula had continued leak despite complete proximal occlusion of ureter owing to retrograde urine reflux from the bladder and was treated with endoscopic injection of intramural calcium hydroxyapatite to the ureteral segment distal to the fistula. Three ureters (33%) in 2 patients with vesicovaginal fistula had recanalization, requiring additional proximal embolization, yielding secondary success rates of 91% (clinical) and 90% (imaging) per ureter. One minor urinary tract infection and no major complications occurred. CONCLUSIONS: Transrenal anterograde ureteral occlusion using EVOH between vascular plugs could be considered a relatively safe and potentially valuable treatment option for refractory ureteral fistulae.
Asunto(s)
Embolización Terapéutica/instrumentación , Cuidados Paliativos , Polivinilos/administración & dosificación , Uréter/fisiopatología , Fístula Urinaria/terapia , Incontinencia Urinaria/terapia , Anciano , Anciano de 80 o más Años , Embolización Terapéutica/efectos adversos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Polivinilos/efectos adversos , Estudios Retrospectivos , Factores de Tiempo , Resultado del Tratamiento , Uréter/diagnóstico por imagen , Fístula Urinaria/diagnóstico por imagen , Fístula Urinaria/etiología , Fístula Urinaria/fisiopatología , Incontinencia Urinaria/diagnóstico por imagen , Incontinencia Urinaria/etiología , Incontinencia Urinaria/fisiopatologíaAsunto(s)
Protocolos Clínicos , Diagnóstico Precoz , Absceso Epidural/diagnóstico por imagen , Imagen por Resonancia Magnética/normas , Mejoramiento de la Calidad , Enfermedades de la Columna Vertebral/diagnóstico por imagen , Medios de Contraste , Toma de Decisiones en la Organización , Eficiencia Organizacional , Medicina Basada en la Evidencia , Humanos , Factores de TiempoRESUMEN
Neurologic complications and conditions associated with pregnancy are rare. Frequently, presenting symptoms of neurologic conditions are nonspecific and can overlap with normal symptoms of pregnancy. As a result, clinical assessment can be insufficient to differentiate symptoms of a normal pregnancy from a neurologic disorder. It is imperative that the radiologist have a basic familiarity with the most common neurologic conditions encountered in pregnancy. The most commonly imaged acute and nonemergent disorders will be described, including eclampsia, cerebrovascular disease including cerebral venous thrombosis, postpartum cerebral angiopathy, multiple sclerosis, tumors, Bell palsy, Guillain-Barré syndrome, and pituitary disorders.
