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Permanent Ureteral Occlusion 

Permanent Ureteral Occlusion
Chapter:
Permanent Ureteral Occlusion
Author(s):

Almamoon I. Justaniah

DOI:
10.1093/med/9780199986071.003.0090
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date: 30 September 2020

Distal ureteral injuries are uncommon. When present, urine leakage may ensue. Common etiologies are gynecologic surgeries (75%), trauma, pelvic malignancy, and radiation therapy. Clinical presentation varies according to the location of leakage or fistula. For example, patients with ureterovaginal fistula may present with vaginal discharge. Patients with intra-abdominal leakage may develop urinoma or abscess. Unfortunately, most of these patients are poor surgical candidates due to prior surgery and/or radiation. Therefore, operative repair can be challenging and at times not a valid option. Transrenal ureteral occlusion may provide the best available option for such patients. A trial of urine diversion via percutaneous nephrostomy tube may allow spontaneous healing. If this fails, ureteral occlusion proximal to the leak/fistula can be attempted with a success rate up to 100%. Occlusion techniques include ureteral clipping, radiofrequency cauterization, embolization coils, Amplatzer vascular plugs, detachable balloons, absolute alcohol, and isobutyl-2-cyanoacrylate (glue).

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