PMC7292167_01
(a) Contrast-enhanced CT scan identifying liquid in the ventral of the patient's sacrum bone (yellow arrowheads) and calcification around the liquid. This suggests calcification is due to radiation. (b) Cystoscope image indicating a fistula of about 2 mm at the left cyst wall. (c) Antegrade pyelography showing we cannot confirm the contrast under both sides of the mid- ureters and in her bladder (red arrow). (d) Cystography showing urine leakage from her left cyst wall (yellow arrow) to the abscess cavity (red arrow).
IJU5-3-21-g001.jpg
PMC7292167_01_IJU5-3-21-g001.jpg
iju512130-fig-0001
This suggested calcification was due to radiation (Fig. 1a). A cystoscope indicated a fistula of about 2 mm at the left bladder wall (Fig. 1b). Antegrade pyelography showed we could not confirm the contrast under both sides of her mid-ureters and in her bladder (Fig. 1c). Cystography showed urine leakage from her left bladder wall to the abscess cavity (Fig. 1d).
CT scans showing we performed CT-scan guided drainage at the site of the retroperitoneal abscess identified in Figure 1a (yellow arrowheads).
IJU5-3-21-g002.jpg
PMC7292167_01_IJU5-3-21-g002.jpg
iju512130-fig-0002
First, we started antibiotic medication and drained the pelvic abscess under the CT-scan guide (Fig. 2).
An open-ended 5-Fr ureteral catheter was advanced over a hydrophilic guide wire in the patient's left cyst wall. NBCA of 1 mL was mixed with iodized oil of 1 mL. After that, we injected the NBCA into the fistula and rapidly withdrew the ureteral catheter.
IJU5-3-21-g003.jpg
PMC7292167_01_IJU5-3-21-g003.jpg
iju512130-fig-0003
After that, we injected NBCA into the fistula and rapidly withdrew the ureteral catheter (Fig. 3).
This cystography shows no leakage after injection of NBCA (red arrow). This figure is more difficult to understand than the actual image. Since NBCA was used as a mixture of contrast agents, it looks as though the occlusion site is angiographically visible and a fistula remains.
IJU5-3-21-g004.jpg
PMC7292167_01_IJU5-3-21-g004.jpg
iju512130-fig-0004
After a few minutes, we performed cystography, which showed no leakage (Fig. 4).