Editorial Comment for Chu et al.

Persistent urinary leaks or urinary fistula formation is a troublesome complication of minimally invasive or open partial nephrectomy. Chu and colleagues outline a clever technique of using a highly flexible 1.9F nitinol basket to fulgurate the fistulous tract and the ureteroscopic injection of fibrin glue to further obliterate the tract.

Our group was one of the first to report the use of electrocautery to fulgurate a persistent fistulous tract between the kidney and duodenum in a stone patient. ¹ Often, a percutaneous approach is helpful, because it can allow easy assessment and dilation of obstruction of infundibula occluded by sutures at the time of partial nephrectomy. ² The advent of improved ureteroscopic skills and equipment may obviate the need for a percutaneous approach.

The successful documentation of using a flexible nitinol basket outlined here is helpful in that a longer portion of the tract can be treated with the electrocautery. While not tested in a prospective randomized fashion, the use of fibrin glue makes sense. Endourologists should keep this technique in mind the next time they encounter a difficult or persistent urinary fistula after partial nephrectomy.