BACKGROUND:

The incidence of urinary fistula after kidney transplantation presents in 1.2 to 8.9% of cases and has been associated with ischemic necrosis of the ureter. Double-J catheter use is recommended to reduce its incidence.

CLINICAL CASE:

A 42-year-old woman underwent a deceased-donor kidney transplantation with ureterovesical reimplantation through the Lich-Gregoire technique. Fourteen days after the procedure she presented with spontaneous urine leakage from the site of the surgical drain. Initial management was bladder diversion for four weeks. There was no improvement and so a 34 Fr x 65 cm (Boston Occluder®) ureteral occlusion balloon catheter was placed next to the bladder catheter and percutaneous nephrostomy was performed. Reduced urine output was achieved after one week. Antegrade pyelography was carried out at week 3 and showed no urine leakage. The occlusion balloon catheter was removed, and a double-J catheter was placed. The clamped nephrostomy and the bladder diversion through the transurethral catheter remained. The ureteral catheter was removed six weeks after the procedure. After 12 months of follow-up the fistula was completely closed, urine volume and serum creatinine, serum urea, and blood urea nitrogen levels were within normal parameters. There were no signs of a compromised kidney graft.

CONCLUSIONS:

The placement of a ureteral occlusion balloon catheter, in addition to nephrostomy, is a new alternative in the treatment of patients with high-volume proximal fistula.

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