Minimally invasive delivery of ethanol for the treatment of urinary bladder fistulas

Urinary bladder fistula formation is a complication of significant morbidity and mortality following pelvic surgery or radiotherapy. Surgical treatment is the definitive management, but it may be contraindicated in patients with significant comorbidities. The alternative approach is to divert urine away from the fistula with stents and catheters, and allow time for healing. The case illustrated herein describes the use of alcohol to accelerate the fibrotic healing of a urinary bladder fistula, based on the premise that sclerosing agents have been effective in the treatment of pancreatic fistulas and renal cysts. A Foley catheter is inserted through the external fistula orifice and passed along the fistula tract into the urinary bladder. The Foley catheter balloon is inflated and pulled back to occlude the fistula. Following this, a vascular sheath is placed alongside the catheter and ethanol is injected into the tract. The alcohol is left to dwell in the fistula for a few minutes, after which time the catheter and sheath are removed. The sclerosant effect of the ethanol aims to induce fibrosis, and therefore occlusion, of the fistula.