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Shamseldin M, Heers H, Steiner T, Puls R. Anatomic locations of ureterovascular fistulae: a review of 532 patients in the literature and a new series of 8 patients. CVIR Endovasc 2024; 7:63. [PMID: 39141215 PMCID: PMC11324626 DOI: 10.1186/s42155-024-00475-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2024] [Accepted: 08/07/2024] [Indexed: 08/15/2024] Open
Abstract
INTRODUCTION Ureterovascular fistula (UVF) is a rare but potentially life-threatening condition. Since its primary description by Moschkowitz in 1908, many case reports, studies and reviews have been written about this condition with the suggestive symptoms and risk factors repeatedly discussed. This study will be focusing on the different locations of 532 out of 605 fistulae published from 1908 up to 2022 besides eight new patients of our own. MATERIAL AND METHODS A systematic review of the literature started using PubMed database searching for "ureteroarterial fistula", "arteriovascular fistula" and "uretero vascular fistula" was performed yielding 122, 62 and 188 results respectively. Those studies and the cited literature in each study were examined to include studies, which did not appear in the primary search. A total of 605 patients in 315 publications were gathered. Only studies mentioning new patients, a clear indication of the location of the UVF, the presence/absence of urinary diversion (UD) as well as the type of UD if present were included. Ten duplicates as well as studies lacking information regarding the UVF and/or the UD (seven publications with 63 patients) were excluded, with 298 publications including 532 external patients remaining. Eight internal cases were included with a total of 540 cases. RESULTS From the 540 included cases, 384 patients (71.1%) had no UD compared to 156 patients (28.9%) with UD. Due to the anatomical ureteral course, the common iliac artery (CIA) was the most common vascular component of UVF, irrespective of the presence or absence of UD. Any dispute to whether the crossing point is the common or the external iliac artery (EIA) was settled for the CIA. Further common vascular components besides CIA include the aorta, EIA, internal iliac artery (IIA) including its branches and vascular bypasses including the anastomosis sites. Other unusual arterial localizations were stated under the "others" category. CONCLUSION Identifying the location of the bleeding artery in UVF is critical and represents the most important step for successful management. We present the largest summary of described locations up to date including our own.
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Affiliation(s)
- Mohammed Shamseldin
- Department of Radiology, Helios Klinikum Erfurt, Nordhäuser Str. 74, Erfurt, 99089, Thuringia, Germany.
| | - Hendrik Heers
- Department of Urology, Universitätsklinikum Gießen Und Marburg, Marburg, Germany
| | - Thomas Steiner
- Department of Urology, Helios Klinikum Erfurt, Erfurt, Thuringia, Germany
| | - Ralf Puls
- Department of Radiology, Helios Klinikum Erfurt, Nordhäuser Str. 74, Erfurt, 99089, Thuringia, Germany
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Özbilen MH, Kısa E, Çapar AE, İlbey YÖ. Life-threatening Arterioureteral Fistula Between Iliac Vessel and Ureteral Stump: A Case Report. JOURNAL OF UROLOGICAL SURGERY 2022. [DOI: 10.4274/jus.galenos.2022.2021.0126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
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Challenges in Diagnosis of Uretero–Arterial Fistulas after Complex Pelvic Oncological Procedures—Single Center Experience and Review of the Literature. Diagnostics (Basel) 2022; 12:diagnostics12081832. [PMID: 36010182 PMCID: PMC9406295 DOI: 10.3390/diagnostics12081832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 07/25/2022] [Accepted: 07/27/2022] [Indexed: 11/17/2022] Open
Abstract
Introduction: Uretero–arterial fistula (UAF) represents a rare condition that manifests as massive or intermittent hematuria and requires collaboration between a urologist, vascular surgeon and interventional radiologist. In this article, we present our experience with UAF diagnosis, treatment pathways and the results of a nonsystematic review of the literature published in the last decade regarding modern diagnostic procedures. Material and method: We analyzed the clinical data of nine consecutive patients from our institution diagnosed with UAF in the interval of 2012–2022 who underwent open or endovascular surgical treatment. We reviewed patient characteristics, diagnoses and treatment pathways. The literature search resulted in 14 case series, published from 2012 to 2022, describing a total of 670 cases of UAF. Results: The mean age of patients in our cohort was 65.3 years (IQR: 51–79). UAFs were more common in women (77.7%). All patients presented a history of surgical intervention and ir-radiation for pelvic malignancy with permanent ureteric stenting. Overall, 88.8% of patients had urinary diversion, either via ileal conduit or cutaneous ureterostomy. The most common clinical manifestation of UAF was gross hematuria with or without clots accompanied by flank pain due to stent obstruction, while three patients presented with hypovolemic shock. Angiography represents the best option for diagnosis, followed by angioCT, with a sensitivity of 59.83% and 47.01%, respectively. There is no definitive imaging modality associated with high accuracy in detecting UAF and negative findings do not exclude the disease. In emergency cases with massive bleeding, surgical exploration remains the most appropriate management option for both diagnosis and treatment. Endovascular stent graft placement is preferred over open surgery in stable hemodynamic patients. Conclusions: Uretero–arterial fistulas represent a life-threatening complication and must be treated with great awareness. Angiography represents the best modality for diagnosis, followed by computed tomography. However, there is no definitive imaging modality and, in some cases, open approach remains the only option for diagnosis and treatment.
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Zaveri S, Shah B, Soufi M, Moszczynski Z, Zuberi J. Arterioureteral Fistula in the Setting of Radical Cystoprostatectomy and Ileal Conduit Creation. Cureus 2022; 14:e24533. [PMID: 35651418 PMCID: PMC9138206 DOI: 10.7759/cureus.24533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2022] [Indexed: 11/05/2022] Open
Abstract
Arterioureteral fistulas (AUF) following ileal conduit reconstruction are rare and not well-studied. We present a life-threatening bleed from an AUF due to an ileal conduit urinary diversion. In addition, we identify the challenges in the diagnostic process as well as management strategies. We present a 63-year-old male with ileal conduit reconstruction for bladder cancer with an AUF developing years after the reconstruction, which was ultimately managed with angioplasty.
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Lock TMTW, Kamphorst K, van den Bergh RCN, Moll FL, de Vries JPPM, Lo RTH, de Kort GAP, Bruijnen RCG, Dik P, Horenblas S, de Kort LMO. Arterio-ureteral fistula: a nationwide cross-sectional questionnaire analysis. World J Urol 2022; 40:831-839. [PMID: 35064800 PMCID: PMC8783176 DOI: 10.1007/s00345-021-03910-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 12/10/2021] [Indexed: 12/19/2022] Open
Abstract
Purpose Arterio-ureteral fistula (AUF) is an uncommon diagnosis, but potentially lethal. Although the number of reports has increased over the past two decades, the true incidence and contemporary urologists’ experience and approach in clinical practice remains unknown. This research is conducted to provide insight in the incidence of AUF in The Netherlands, and the applied diagnostic tests and therapeutic approaches in modern practice. Methods A nationwide cross-sectional questionnaire analysis was performed by sending a survey to all registered Dutch urologists. Data collection included information on experience with patients with AUF; and their medical history, diagnostics, treatment, and follow-up, and were captured in a standardized template by two independent reviewers. Descriptive statistics were used. Results Response rate was 62% and 56 AUFs in 53 patients were reported between 2003 and 2018. The estimated incidence of AUF in The Netherlands in this time period is 3.5 AUFs per year. Hematuria was observed in all patients; 9% intermittent microhematuria, and 91% presenting with, or building up to massive hematuria. For the final diagnosis, angiography was the most efficient modality, confirming diagnosis in 58%. Treatment comprised predominantly endovascular intervention. Conclusion The diagnosis AUF should be considered in patients with persistent intermittent or massive hematuria. Supplementary Information The online version contains supplementary material available at 10.1007/s00345-021-03910-3.
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Affiliation(s)
- Tycho M T W Lock
- Department of Urology, University Medical Centre Utrecht, P.O. BOX 85500, 3508 GA, Utrecht, The Netherlands.
| | - Kyara Kamphorst
- Department of Urology, University Medical Centre Utrecht, P.O. BOX 85500, 3508 GA, Utrecht, The Netherlands
| | | | - Frans L Moll
- Division of Vascular Surgery, Department of Surgery, University Medical Centre Utrecht, P.O. BOX 85500, 3508 GA, Utrecht, The Netherlands
| | - Jean-Paul P M de Vries
- Division of Vascular Surgery, Department of Surgery, University Medical Centre Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - Rob T H Lo
- Department of Interventional Radiology, University Medical Centre Utrecht, P.O. BOX 85500, 3508 GA, Utrecht, The Netherlands
| | - Gérard A P de Kort
- Department of Interventional Radiology, University Medical Centre Utrecht, P.O. BOX 85500, 3508 GA, Utrecht, The Netherlands
| | - Rutger C G Bruijnen
- Department of Interventional Radiology, University Medical Centre Utrecht, P.O. BOX 85500, 3508 GA, Utrecht, The Netherlands
| | - Pieter Dik
- Department of Pediatric Urology, Wilhelmina Children's Hospital UMC Utrecht, Utrecht, The Netherlands.,Division of Pediatric Urology and Andrology, Department of Pediatric Surgery, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - Simon Horenblas
- Department of Urology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - Laetitia M O de Kort
- Department of Urology, University Medical Centre Utrecht, P.O. BOX 85500, 3508 GA, Utrecht, The Netherlands
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Chen JJ, Wang J, Zheng QG, Sun ZH, Li JC, Xu ZL, Huang XJ. Uretero-lumbar artery fistula: A case report. World J Clin Cases 2021; 9:10013-10017. [PMID: 34877344 PMCID: PMC8610900 DOI: 10.12998/wjcc.v9.i32.10013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 07/29/2021] [Accepted: 09/10/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Uretero-arterial fistula (UAF) is a disease that usually involves the aorta, common iliac artery, external iliac artery, hypogastric artery, and lumbar artery. Among them, uretero-lumbar artery fistula (ULAF) is the most unusual type. So, both in China and around the world, the diagnosis and treatment of ULAF is a big challenge.
CASE SUMMARY A 55-year-old female patient with a history of pelvic radiotherapy developed unexplained massive hemorrhage during replacement of the right Resonance metallic ureteral double-J tubes due to a long-standing indwelling ureteral stent for ureteral stricture. Later, we found contrast extravasation from the patient's right L4 artery into the ureter under digital subtraction angiography (DSA) and administered polyvinyl alcohol particle embolic agent and coil embolization; hematuria was controlled. Follow-up investigations at 18 mo showed no sign of recurrence.
CONCLUSION DSA is very important in the diagnosis and treatment of UAF, and DSA should be preferred when UAF is suspected. In addition, the use of softer ureteral stents in patients with primary disease and risk factors for UAF should be considered to avoid increasing the risk of the development of the disease; endovascular treatment should be preferred in patients who have developed UAF.
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Affiliation(s)
- Jia-Jian Chen
- The Second Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou 310053, Zhejiang Province, China
| | - Jian Wang
- The Second Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou 310053, Zhejiang Province, China
| | - Qi-Gang Zheng
- The Second Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou 310053, Zhejiang Province, China
| | - Zhao-Hui Sun
- The Second Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou 310053, Zhejiang Province, China
| | - Jia-Cheng Li
- The Second Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou 310053, Zhejiang Province, China
| | - Zi-Lei Xu
- The Second Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou 310053, Zhejiang Province, China
| | - Xiao-Jun Huang
- Department of Urology, The Second Clinical Medical College of Zhejiang Chinese Medical University, The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou 310005, Zhejiang Province, China
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Ghouti C, Leon G, Seddik S, Ait Said K, Vaudreuil L, Tillou X. Uretero-arterial fistula: Six new cases and systematic review of the literature. Prog Urol 2021; 31:605-617. [PMID: 34158218 DOI: 10.1016/j.purol.2020.12.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 11/22/2020] [Accepted: 12/06/2020] [Indexed: 10/21/2022]
Abstract
AIM Secondary uretero-arterial fistulas (SUAF) are uncommon, underrated and threatening for any patient. Gross hematuria is a clinical symptom of this pathology for patients with history of pelvic radiotherapy, complex pelvic surgery or long-term ureteral stenting. The purpose of this work is to assess risk factors, diagnosis and treatment of SUAF. METHODS Monocentric and retrospective series of 6 new cases illustrated by a literature review through MedLine and Pubmed using the keywords "arterio-ureteral fistula", "arterio iliac fistula" and "ilio-ureteral fistula". We excluded uretero-arterial fistula following vascular surgery. RESULTS Our series included 4 men and 2 women. All patients had a history of complex pelvic surgery and long-term ureteral stenting. Three patients had history of pelvic radiotherapy. They all had inaugural macroscopic haematuria episode. Two fistula cases were diagnosed on 5 repeated CT-scans. In 2 out of 5 cases, arteriography highlighted the fistula. Fistulas were generally located at the left common iliac artery. An endovascular stent was placed in 5 out of 6 cases. One patient needed open surgery. After treatment, 3 patients remained alive, 3 patients died either by a fistula relapse or by complications late in the treatment. CONCLUSION SUAF are uncommon, but serious. Today, there is no specific recommendation regarding complex treatment of these fistulas. Endovascular stents seem to be a good therapeutic option. LEVEL OF PROOF 3.
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Affiliation(s)
- C Ghouti
- Urology department, University Hospital Caen, Caen, France
| | - G Leon
- Urology department, University Hospital Caen, Caen, France
| | - S Seddik
- Urology department, University Hospital Caen, Caen, France
| | - K Ait Said
- Urology department, University Hospital Caen, Caen, France
| | - L Vaudreuil
- Urology department, University Hospital Caen, Caen, France
| | - X Tillou
- Urology department, University Hospital Caen, Caen, France.
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Nakama R, Arai Y, Takei Y, Kobayashi T. Successful transcatheter arterial embolization for uretero-inferior epigastric arterial fistula: A rare complication of cutaneous ureterostomy. Urol Case Rep 2021; 38:101726. [PMID: 34094878 PMCID: PMC8166751 DOI: 10.1016/j.eucr.2021.101726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Revised: 05/13/2021] [Accepted: 05/16/2021] [Indexed: 11/19/2022] Open
Abstract
A 70-year-old man presented with pulsatile bleeding upon changing his catheter for cutaneous ureterostomy. He was suspected to have a uretero-arterial fistula. Computed tomography showed an abnormally dilated right inferior epigastric artery, the suspected bleeding source. Angiography revealed a tortuous dilated branch from the inferior epigastric artery. Transcatheter arterial embolization was performed with a gelatin sponge and coil. He was discharged 15 days after the procedure. Uretero-arterial fistula is a rare but fatal complication among patients with long-term indwelling ureter catheters. An abnormal inferior epigastric artery surrounding the cutaneous ureterostomy should be considered a rare cause of uretero-arterial fistula.
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Tong E, Hunter K, Deegan J, Torreggiani WC. Safely increasing nephro-ureteric stent exchange intervals, resulting in significant cost savings for the interventional radiology suite, a 2-year experience in a tertiary referral centre. Ir J Med Sci 2021; 191:1349-1353. [PMID: 34091859 PMCID: PMC9135782 DOI: 10.1007/s11845-021-02657-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 05/19/2021] [Indexed: 11/25/2022]
Abstract
Aim To evaluate the nephro-ureteric stent (NUS) insertion and exchange practice in a tertiary referral cancer centre, and determine the safety and compliance with current guidelines. We also reviewed if increasing exchange time interval from 6 to 12 weeks was safe, and if this could be adopted into our local guidelines. Methods A retrospective review was performed covering 24 months from January 2017 to December 2018. All NUS insertions and exchanges performed in that period were analysed, including the number of exchanges the patient underwent, the time between subsequent exchanges, and the screening time. We also reviewed the indications for stent insertion, possible causes for failed stent exchange, and factors which led to significant delays in stent exchanges for some patients. A scatterplot of screening time versus time in situ was derived and correlation analysis performed using the Pearson coefficient. Results Thirty-two patients underwent de novo NUS insertion during the period, and 102 NUS exchanges were performed. The interval between stent exchanges ranged from 1 to 40 weeks, with a mean of 12.3 weeks (SD = 8.96 weeks). Screening time ranged from 33 s to 17 min, with a mean of 3 min 50 s (SD = 3 min 35 s). There were 100 successful exchanges, and two failed exchanges, accounting for 1.9% of total exchanges. In both failed cases, the reason for failed exchange was due to a prolonged period between exchanges (6 months in both cases). The reason for delay for stent exchange was due to non-attendance for scheduled appointments. There was a weakly positive correlation coefficient of 0.06 (screening time versus time period between insertions); however, this was not statistically significant (p = 0.81). Conclusion In this retrospective review, we have demonstrated that the recommended 6-week period between stent exchanges is unnecessary in the vast majority of cases, and that a longer interval between NUS exchanges, e.g. 8–12 weeks, is safe for the patient, and reduces screening time. This reduction in procedures also provides a significant potential saving to the radiology department in both monetary expense and limited angiography suite time.
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Affiliation(s)
- Emma Tong
- Department of Radiology, Tallaght University Hospital, Dublin, Ireland.
| | - Kate Hunter
- Department of Radiology, Tallaght University Hospital, Dublin, Ireland
| | - Joe Deegan
- Department of Medicine, Trinity College Dublin, Dublin, Ireland
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Kim D, Shim DJ. Critical Role of Clinical Suspicion in the Diagnosis of Arterio-Ureteral Fistula. TAEHAN YONGSANG UIHAKHOE CHI 2021; 82:764-765. [PMID: 36238787 PMCID: PMC9432443 DOI: 10.3348/jksr.2020.0178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 10/30/2020] [Accepted: 10/30/2020] [Indexed: 11/21/2022]
Affiliation(s)
- Doyoung Kim
- Department of Radiology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea
| | - Dong Jae Shim
- Department of Radiology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea
- Department of Radiology, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Sachsamanis G, Pfister K, Kasprzak PM, Schierling W, Denzinger S, Oikonomou K. Midterm Results after Open Surgical and Endovascular Management of Arterioureteral Fistula. Ann Vasc Surg 2020; 73:280-289. [PMID: 33359692 DOI: 10.1016/j.avsg.2020.11.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 11/19/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Arterioureteral fistula refers to the anomalous fistulous connection between the iliac artery and the ureter. It is often associated with pelvic malignancy, abdominal surgery, and radiation. As it is a potentially life-threatening condition, prompt diagnosis and management is essential. METHODS We performed a retrospective analysis of patients treated for arterioureteral fistula in a single-vascular institution from January 2013 to March 2019. Preoperative assessment included physical and laboratory examinations and medical history, with diagnosis established through computed tomography angiography, digital subtraction angiography, or ureteroscopy. Parameters analyzed included perioperative mortality and morbidity as well as treatment durability during midterm follow-up. RESULTS Nine patients with ten arterioureteral fistulas were included in the study. Macroscopic hematuria was the main presenting symptom, with 2 patients admitted due to hemorrhagic shock. Endovascular treatment was carried out in 6 patients. In 4 cases, single stent-graft deployment inside the common iliac artery was performed, in one case in combination with plugging of the internal iliac artery. One patient underwent implantation of an iliac-branched device, whereas in another patient coiling of the internal iliac artery sufficed for management of the fistula. Open surgical repair was carried out in three cases. Perioperative mortality was zero; one patient had prolonged hospital stay due to superficial wound infection. Recurrent hematuria and stent-graft infection were observed during follow-up in three patients after endovascular repair, all of them treated through open surgery with no further complications. One patient developed an enterocutaneous fistula after open repair during follow-up and required redo surgery. DISCUSSION Arterioureteral fistula is a challenging clinical scenario demanding prompt diagnosis and management. Open surgery remains the treatment of choice in cases of preexisting vascular reconstruction or manifest infection. Endovascular techniques offer a viable solution in significantly comorbid patients or in patients presenting with acute, life-threatening bleeding. Rigorous follow-up is required regardless of treatment modality due to the considerable rate of reinterventions.
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Affiliation(s)
- Georgios Sachsamanis
- Department of Vascular Surgery, University Medical Center Regensburg, Regensburg, Germany.
| | - Karin Pfister
- Department of Vascular Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Piotr M Kasprzak
- Department of Vascular Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Wilma Schierling
- Department of Vascular Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Stefan Denzinger
- Department of Urology, Caritas-Hospital Saint Josef Regensburg, Regensburg, Germany
| | - Kyriakos Oikonomou
- Department of Vascular Surgery, University Medical Center Regensburg, Regensburg, Germany
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Kaneko T, Sakamoto A, Yamada Y, Yamamoto M, Kondo H, Nakagawa T. Uretero-arterial fistula treated with endovascular stent graft following multiple interventions. IJU Case Rep 2020; 3:275-277. [PMID: 33163924 PMCID: PMC7609180 DOI: 10.1002/iju5.12216] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 08/09/2020] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION Uretero-arterial fistula is a rare life-threatening condition. Its diagnosis and management remains a challenge for urologists. CASE PRESENTATION A 64-year-old man presented to our hospital with gross hematuria. He had history of rectal cancer treated with neoadjuvant chemoradiotherapy followed by low anterior resection and chronic ureteral stenting for bilateral ureteral strictures. He developed recurrent hemorrhagic shocks due to sudden massive gross hematuria. Repeated computed tomography and angiography could not identify the source of bleeding. After prophylactic embolization of the right renal artery and right nephrectomy, angiography finally revealed a uretero-arterial fistula from the right external iliac artery. Percutaneous balloon-expandable covered stent graft was used to successfully treat the fistula. CONCLUSIONS Urologists should consider possible uretero-arterial fistula in patients with recurrent hematuria along with several risk factors and convincing medical history.
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Affiliation(s)
- Tomoyuki Kaneko
- Department ofUrologyTeikyo University School of MedicineTokyoJapan
| | - Akihiko Sakamoto
- Department ofUrologyTeikyo University School of MedicineTokyoJapan
| | - Yukio Yamada
- Department ofUrologyTeikyo University School of MedicineTokyoJapan
| | | | - Hiroshi Kondo
- Department ofRadiologyTeikyo University School of MedicineTokyoJapan
| | - Tohru Nakagawa
- Department ofUrologyTeikyo University School of MedicineTokyoJapan
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Tijunaitis K, Mosenko V, Baltrūnas T. A Bleeding Uretero-Arterial Fistula: Open Repair After Unsuccessful Endovascular Treatment. Vasc Endovascular Surg 2020; 55:171-176. [PMID: 32873221 DOI: 10.1177/1538574420953964] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Uretero-arterial fistula (UAF) poses major challenges in management and diagnosis due to the rarity of this condition and associated high morbidity/mortality rates. METHODS We describe a case of a UAF associated with previous aorto-biiliac grafting, ureteric stenting and right nephrectomy because of chronic pielonephritis and complicated by surgical site infection. This case illustrates a very complex pathology, with a challenging diagnosis and multiple treatment options. RESULTS A 72 year-old woman was referred to Vilnius Vascular Unit for open UAF repair. The patient had a history of open abdominal aortic aneurysm repair using a bifurcated graft 25 years ago. The right ureter was injured during the operation and a rigid indwelling ureteric stent was inserted. Six months prior to referral, she underwent a right nephrectomy due to a chronic pyelonephritis, complicated by surgical site infection, which was still present at the time of admission. Initial CTA demonstrated bilateral iliac aneurysms, but no signs of UAF. A further CTA revealed a UAF between the right ureteral stump and the right common iliac artery (CIA) para-anastomotic aneurysm. After unsuccessful attempts to embolize the UAF using both coils and glue, the patient was referred to Vilnius Vascular Unit for open repair. Left axillo-bifemoral bypass reconstruction was performed followed by UAF repair and bifurcated graft explantation. Follow-up after 2 years showed no recurrence of haematuria, good function of the remaining kidney and patent axillo-bifemoral bypass with no signs of infection around the prosthetic aortic stump. CONCLUSIONS Uretero-arterial fistula is a uncommon condition in everyday clinical practice. The rarity of this condition may lead to delayed or missed diagnosis which can result in life-threating consequences. A multidisciplinary approach involving urologists, vascular surgeon and radiologist are crucial to both the diagnosis and managment of this rare entity.
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Affiliation(s)
| | - Valerija Mosenko
- 68626Vilnius University Faculty of Medicine, Vilnius University Hospital Santaros Clinics, Vilnius, Lithuania
| | - Tomas Baltrūnas
- 58939Vilnius University Hospital Santaros Clinics, Vilnius, Lithuania
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Callegari M, Thomas J, Shekar A, Fernstrum A, Chen M, Bose S, Ponsky L, Abdel-Azim A, Kashyap V, Tavri S. Arterioureteral Fistula in the Setting of an Indwelling Ureteral Stent, Ileal Conduit and History of Pelvic Radiation. Urology 2020; 140:14-17. [DOI: 10.1016/j.urology.2020.03.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 02/24/2020] [Accepted: 03/09/2020] [Indexed: 11/26/2022]
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Tatsuishi W, Konno N, Hatori K, Yoshizumi T, Shibuya K, Abe T. Successful Endovascular Repair of a Ruptured Common Iliac Artery Aneurysm Associated with an Ileal Pouch Neobladder Fistula. Ann Vasc Surg 2020; 69:448.e9-448.e13. [PMID: 32473305 DOI: 10.1016/j.avsg.2020.05.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 04/28/2020] [Accepted: 05/10/2020] [Indexed: 11/30/2022]
Abstract
A spontaneous fistula between a ruptured common iliac artery aneurysm and the ileal pouch neobladder is quite rare. We present the case of a 74-year-old man presenting with intense abdominal pain and massive hematuria. Computed tomography angiography revealed a ruptured common iliac artery aneurysm-ileal pouch neobladder fistula. His hemodynamics was unstable; emergent endovascular aortic repair was performed successfully. Infection and dysfunction of the neobladder were avoided owing to appropriate management.
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Affiliation(s)
- Wataru Tatsuishi
- Division of Cardiovascular Surgery, Department of General Surgical Science, Gunma University, Maebashi, Gunma, Japan.
| | - Naoki Konno
- Division of Cardiovascular Surgery, Department of General Surgical Science, Gunma University, Maebashi, Gunma, Japan
| | - Kyohei Hatori
- Division of Cardiovascular Surgery, Department of General Surgical Science, Gunma University, Maebashi, Gunma, Japan
| | - Tomo Yoshizumi
- Division of Cardiovascular Surgery, Department of General Surgical Science, Gunma University, Maebashi, Gunma, Japan
| | - Kei Shibuya
- Department of Radiology, Gunma University, Maebashi, Gunma, Japan
| | - Tomonobu Abe
- Division of Cardiovascular Surgery, Department of General Surgical Science, Gunma University, Maebashi, Gunma, Japan
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16
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Jaha L, Ismaili-Jaha V, Ademi B, Veselaj F, Kryeziu D, Gjikolli B, Gecaj-Gashi A, Koshi A, Jaha A. Massive hematuria due to an autogenous saphenous vein graft and urinary bladder fistula in an extra-anatomic iliofemoral bypass: a case report. J Med Case Rep 2019; 13:359. [PMID: 31812163 PMCID: PMC6899332 DOI: 10.1186/s13256-019-2300-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 10/18/2019] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION Gross hematuria caused by rupture of an artery in the urinary tract is a rare but potentially fatal condition. Iliac artery aneurysms, pelvic surgery with radiation, vascular reconstructive surgery, surgery for stenosis of the ureteropelvic junction, and transplantation are reported to be associated with this condition. In the vascular reconstructive surgery group, the most common etiology is rupture of the degenerated artery or synthetic graft in the ureter. CASE PRESENTATION We present a case of rupture of the small anastomotic pseudoaneurysm at the proximal anastomosis of a right iliofemoral autogenous vein extra-anatomic graft in the urinary bladder. To our knowledge, this is the first report of a rupture of an autogenous vein graft in the urinary bladder. Our patient, a 24-year-old Albanian farmer, was admitted to the emergency department in severe hemorrhagic shock induced by exsanguinating hematuria. He underwent immediate surgery, during which direct sutures to the bladder were placed and the saphenous graft was replaced with a synthetic one. The patient recovered completely, was free of hematuria, and showed no signs of pathological communication between the urinary and arterial tracts on postoperative cystoscopy and computed tomographic angiography during 2 years of follow-up. CONCLUSION The incidence of artery-to-urinary tract fistulas is growing due to the increasing use of urologic and vascular surgery, pelvic oncologic surgery, and radiation therapy. In addition to fistulas involving a degenerated artery and ureter or synthetic grafts and ureter, they can also involve an autogenous vein graft and the urinary bladder. In our patient, the fistula was a result of erosion of the bladder from a pseudoaneurysm at the proximal anastomosis of an autogenous vein iliofemoral bypass in an extra-anatomic position. Open surgery remains the best treatment option, although there is increasing evidence of successful endovascular treatment.
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Affiliation(s)
- Luan Jaha
- Department of Vascular Surgery, University Clinical Center of Kosovo, Pristina, Republic of Kosovo
| | - Vlora Ismaili-Jaha
- Faculty of Medicine, University “Hasan Prishtina”, Rrethi i Spitalit p.n., 10000 Prishtina, Republic of Kosovo
| | - Bekim Ademi
- Department of Vascular Surgery, University Clinical Center of Kosovo, Pristina, Republic of Kosovo
| | - Fahredin Veselaj
- Department of Urology, University Clinical Center of Kosovo, Pristina, Republic of Kosovo
| | - Destan Kryeziu
- Department of Urology, University Clinical Center of Kosovo, Pristina, Republic of Kosovo
| | - Bujar Gjikolli
- Department of Radiology, University Clinical Center of Kosovo, Pristina, Republic of Kosovo
| | - Agreta Gecaj-Gashi
- Department of Anesthesiology and Intensive Care, University Clinical Center of Kosovo, Pristina, Republic of Kosovo
| | - Adhurim Koshi
- Department of Vascular Surgery, University Clinical Center of Kosovo, Pristina, Republic of Kosovo
| | - Art Jaha
- Faculty of Medicine, University “Hasan Prishtina”, Rrethi i Spitalit p.n., 10000 Prishtina, Republic of Kosovo
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17
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Titomihelakis G, Feghali A, Nguyen T, Salvatore D, DiMuzio P, Abai B. Endovascular management and the risk of late failure in the treatment of ureteroarterial fistulas. JOURNAL OF VASCULAR SURGERY CASES INNOVATIONS AND TECHNIQUES 2019; 5:396-401. [PMID: 31660458 PMCID: PMC6806659 DOI: 10.1016/j.jvscit.2019.06.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2019] [Accepted: 06/30/2019] [Indexed: 12/17/2022]
Abstract
Ureteroarterial fistula (UAF) is a rare and life-threatening source of hematuria. A high index of suspicion is warranted for early diagnosis and timely intervention. Because of high perioperative risk and comorbidities in UAF patients, the endovascular approach has become preferred for repair. Infection can complicate this mode of therapy, and treatment with antibiotics is important. Herein we present five cases of secondary UAFs treated with stent graft alone or stent graft and embolization.
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Affiliation(s)
- George Titomihelakis
- Division of Vascular Surgery, Thomas Jefferson University Hospital, Philadelphia, Pa
| | - Anthony Feghali
- Division of Vascular Surgery, Thomas Jefferson University Hospital, Philadelphia, Pa
| | - Tuong Nguyen
- Division of Vascular Surgery, Thomas Jefferson University Hospital, Philadelphia, Pa
| | - Dawn Salvatore
- Division of Vascular Surgery, Thomas Jefferson University Hospital, Philadelphia, Pa
| | - Paul DiMuzio
- Division of Vascular Surgery, Thomas Jefferson University Hospital, Philadelphia, Pa
| | - Babak Abai
- Division of Vascular Surgery, Thomas Jefferson University Hospital, Philadelphia, Pa
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18
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Yamazaki H, Nakamura T, Otsuki Y, Tsuchiya M, Hamano T, Adachi H. Sudden fatal bleeding from a uretero-arterial fistula combined with pre-existing uretero-colic and uretero-vaginal fistulas 7 years after a cervical cancer surgery: a case report. Surg Case Rep 2019; 5:85. [PMID: 31123939 PMCID: PMC6533329 DOI: 10.1186/s40792-019-0642-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 05/12/2019] [Indexed: 12/22/2022] Open
Abstract
Background Uretero-arterial fistulas (UAFs) are a rare cause of hematuria and could be fatal often due to a diagnostic delay despite recent advances in the treatment modalities. Case presentation A 52-year-old woman with a history of advanced cervical cancer developed a fever and was diagnosed with a left uretero-colic fistula. She also had a uretero-vaginal fistula and suffered from repeated urinary tract infections over 6 years. While waiting for an elective colostomy, she developed sudden perineal bleeding and died 14 h after the onset. The autopsy findings revealed that bleeding from a newly developed UAF spreads out to the extracorporeal space through the pre-existing fistulas. Conclusions Bleeding from a UAF complicated by other uretero-genital and/or uretero-enteric fistulas could proceed rapidly resulting in a fatal outcome because of a lack of a tamponade effect. Early recognition of a UAF in high-risk patients is crucial for a prompt diagnosis, which might lead to a treatment success.
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Affiliation(s)
- Hiroki Yamazaki
- Department of Gynecology, Seirei Hamamatsu General Hospital, 2-12-12 Sumiyoshi, Hamamatsu City, Shizuoka, Japan.
| | - Toru Nakamura
- Department of General Thoracic Surgery, Seirei Hamamatsu General Hospital, 2-12-12 Sumiyoshi, Hamamatsu City, Shizuoka, Japan
| | - Yoshiro Otsuki
- Department of Pathology, Seirei Hamamatsu General Hospital, 2-12-12 Sumiyoshi, Hamamatsu City, Shizuoka, Japan
| | - Mitsuteru Tsuchiya
- Department of Radiology, Seirei Hamamatsu General Hospital, 2-12-12 Sumiyoshi, Hamamatsu City, Shizuoka, Japan
| | - Takashi Hamano
- Department of General Thoracic Surgery, Seirei Hamamatsu General Hospital, 2-12-12 Sumiyoshi, Hamamatsu City, Shizuoka, Japan
| | - Hiroshi Adachi
- Department of Gynecology, Seirei Hamamatsu General Hospital, 2-12-12 Sumiyoshi, Hamamatsu City, Shizuoka, Japan
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19
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ILIOURETERAL FISTULA CAUSED BY URETERAL STENT IN A PATIENT WITH A BRICKER UNIRARY DIVERSION. ANGIOLOGIA 2019. [DOI: 10.20960/angiologia.00079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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20
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von Klot CAJ, Fricke R, Kuczyk MA, Tezval H. [Massive bleeding of the urogenital tract]. Internist (Berl) 2018; 58:233-242. [PMID: 28124079 DOI: 10.1007/s00108-016-0188-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Massive bleeding of the urogenital tract is, in the same way as acute bleeding from all other organs, a medical emergency and necessitates precise diagnostics and treatment. In this article the topic is addressed in four main categories: first the inflammatory causes are discussed, followed by surgical, traumatic and neoplastic causes of massive bleeding. Subsequently, the rare but clinically relevant causes of acute and massive bleeding are described.
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Affiliation(s)
- C-A J von Klot
- Klinik für Urologie und Urologische Onkologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland
| | - R Fricke
- Klinik für Urologie und Urologische Onkologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland
| | - M A Kuczyk
- Klinik für Urologie und Urologische Onkologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland
| | - H Tezval
- Klinik für Urologie und Urologische Onkologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland.
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21
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Subiela JD, Balla A, Bollo J, Dilme JF, Soto Carricas B, Targarona EM, Rodriguez-Faba O, Breda A, Palou J. Endovascular Management of Ureteroarterial Fistula: Single Institution Experience and Systematic Literature Review. Vasc Endovascular Surg 2018; 52:275-286. [DOI: 10.1177/1538574418761721] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Background: Ureteroarterial fistula (UAF) represents an uncommon complication after urological surgery; however, this is a well-documented condition in patients with predisposing risk factors. The aim of the present study is to report and analyze the endovascular management of a series of patients with UAF, treated in authors’ hospital, and to report and analyze the same data concerning patients retrieved from a systematic literature review. Methods: Authors conducted a retrospective analysis of prospectively collected data and a systematic literature review. The research was carried out through PubMed database searching the following keywords: “uretero arterial fistula” and “uretero iliac fistula.” It includes only articles reporting the endovascular management. Results: Forty-six articles were included in the present study for a total of 94 patients. Risk factors were as follows: chronic indwelling ureteral stents, pelvic surgery, radiotherapy, iliac artery pseudo-aneurysm, and chemotherapy. All patients had gross hematuria at presentation. Stent graft placement was performed in 89 patients, embolization in 5 patients, and iliac internal artery embolization combined with stent graft placement was performed in 24 patients. Four postprocedural complications were observed (4.2%). During a median follow-up of 8 months, 10 complications related to UAF were observed (10.6%): rebleeding (7 cases) and stent thrombosis (3 cases). Two patients died for causes related to UAF (2.1%): rebleeding (1) and retroperitoneal abscess (1). Conclusion: Based on the present data, endovascular treatment is feasible and safe with low postprocedural complications and mortality rate. Considering the increase in surgery and radiotherapy performed, UAF should be always debated in patients with massive hematuria.
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Affiliation(s)
- José D. Subiela
- Department of Urology, Fundació Puigvert, Universidad Aurtónoma de Barcelona, Barcelona, Spain
| | - Andrea Balla
- General and Digestive Surgery Unit, Hospital de la Santa Creu i Sant Pau, Universidad Autónoma de Barcelona, Barcelona, Spain
- Department of General Surgery and Surgical Specialties “Paride Stefanini,” Sapienza, University of Rome, Rome, Italy
| | - Jesús Bollo
- General and Digestive Surgery Unit, Hospital de la Santa Creu i Sant Pau, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Jaume F. Dilme
- Departament of Vascular Surgery, Hospital de la Santa Creu i Sant Pau, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Begoña Soto Carricas
- Departament of Vascular Surgery, Hospital de la Santa Creu i Sant Pau, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Eduard M. Targarona
- General and Digestive Surgery Unit, Hospital de la Santa Creu i Sant Pau, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Oscar Rodriguez-Faba
- Department of Urology, Fundació Puigvert, Universidad Aurtónoma de Barcelona, Barcelona, Spain
| | - Alberto Breda
- Department of Urology, Fundació Puigvert, Universidad Aurtónoma de Barcelona, Barcelona, Spain
| | - Juan Palou
- Department of Urology, Fundació Puigvert, Universidad Aurtónoma de Barcelona, Barcelona, Spain
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22
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Kim M, Hong B, Park HK. Long-Term Outcomes of Double-Layered Polytetrafluoroethylene Membrane-Covered Self-Expandable Segmental Metallic Stents (Uventa) in Patients with Chronic Ureteral Obstructions: Is It Really Safe? J Endourol 2016; 30:1339-1346. [DOI: 10.1089/end.2016.0462] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Myong Kim
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Bumsik Hong
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Hyung Keun Park
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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23
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Unique Presentation of Hematuria in a Patient with Arterioureteral Fistula. Case Rep Radiol 2016; 2016:8682040. [PMID: 27293944 PMCID: PMC4880677 DOI: 10.1155/2016/8682040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2016] [Accepted: 04/26/2016] [Indexed: 12/03/2022] Open
Abstract
Active extravasation via an arterioureteral fistula (AUF) is a rare and life-threatening emergency that requires efficient algorithms to save a patient's life. Unfortunately, physicians may not be aware of its presence until the patient is in extremis. An AUF typically develops in a patient with multiple pelvic and aortoiliac vascular surgeries, prior radiation therapy for pelvic tumors, and chronic indwelling ureteral stents. We present a patient with a left internal iliac arterial-ureteral fistula and describe the evolution of management and treatment algorithms based on review of the literature.
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24
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Minimally invasive radiologic techniques in the treatment of uretero-enteric fistulas. Diagn Interv Imaging 2015; 96:1153-60. [DOI: 10.1016/j.diii.2015.06.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2015] [Revised: 06/11/2015] [Accepted: 06/12/2015] [Indexed: 01/06/2023]
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25
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[MASSIVE HEMORRHAGE FROM THE FISTULA FORMATION BETWEEN CUTANEOUS URETEROSTOMY AND INFERIOR EPIGASTRIC ARTERY: A CASE REPORT]. Nihon Hinyokika Gakkai Zasshi 2015; 106:127-31. [PMID: 26415365 DOI: 10.5980/jpnjurol.106.127] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
A 87-year-old man received radical nephroureterectomy for right renal pelvic cancer in 2009 and left cutaneous ureterostomy after radical cystectomy for bladder cancer in 2013. He visited the hospital for exchanging a 7 or 8 Fr single-J catheter every 2 to 4 weeks. Eleven months after the 2nd operation, massive bleeding from the stoma occurred when ureteral catheter was exchanged. Contrast-enhanced computed tomography showed that left inferior epigastric artery was located close to left ureter. Angiography of the left inferior epigastric artery didn't show an obvious fistula, but revealed the stoma was surrounded by ramified new blood vessels from left inferior epigastric artery. We suspected a rupture of the vessels and performed embolization for the branch of inferior epigastric artery to left ureter. This embolization made it possible for the bleeding to be controlled. Massive bleeding from the branch of inferior epigastric artery is very rare, and we report the case and review the literature.
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26
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Najefi A, Alleemudder A, Mambu L, Jones S, Syed I, Gujral SS. Ureteral perigraft fistula: a case report and review of the literature. JOURNAL OF CLINICAL UROLOGY 2015. [DOI: 10.1177/2051415813516952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- A Najefi
- Urology Department, King George Hospital, UK
| | | | - L Mambu
- Urology Department, King George Hospital, UK
| | - S Jones
- Urology Department, King George Hospital, UK
| | - I Syed
- Urology Department, King George Hospital, UK
| | - SS Gujral
- Urology Department, King George Hospital, UK
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27
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Das A, Lewandoski P, Laganosky D, Walton J, Shenot P. Ureteroarterial fistula: A review of the literature. Vascular 2015; 24:203-7. [PMID: 25972027 DOI: 10.1177/1708538115585261] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Ureteroarterial fistulas are rare, erosive defects that occur between the distal segments of the ureter and the adjacent blood vessels in individuals with urologic and vascular comorbidities. Characterized by diffuse, pulsatile bleeding into the urinary tract, this condition carries a significant mortality rate in the absence of early recognition. Recent treatment efforts have focused on use of endovascular stenting techniques as an alternative to open surgical closure of the underlying defects in hemodynamically stable patients. We provide a literature review detailing the characteristics, mechanism, and management of ureteroarterial fistulas.
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Affiliation(s)
- Akhil Das
- Department of Urology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Patricia Lewandoski
- Department of Urology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Dean Laganosky
- Department of Urology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - John Walton
- Department of Urology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Patrick Shenot
- Department of Urology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
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28
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29
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Fiuk J, Bao Y, Calleary JG, Schwartz BF, Denstedt JD. The use of internal stents in chronic ureteral obstruction. J Urol 2014; 193:1092-100. [PMID: 25463984 DOI: 10.1016/j.juro.2014.10.123] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/23/2014] [Indexed: 02/05/2023]
Abstract
PURPOSE Despite the lack of a well delineated definition, chronic ureteral obstruction imposes significant quality of life loss, increased pathological morbidity and risk of mortality as well as substantial economic burden. Ureteral stenting serves as an important therapeutic option to alleviate obstruction. Thus, we assessed the recently published literature on chronic ureteral obstruction; treatment options; types, benefits and shortcomings of current ureteral stents; as well as outcomes and complications of chronic ureteral stenting, with the goal of providing concise management guidelines. MATERIALS AND METHODS A systemic literature review was performed on Embase™, PubMed®, Cochrane Controlled Trials Register and Google Scholar™ on ureteral obstruction and internal ureteral stents. Relevant reviews, original research articles and their cited references were examined, and a synopsis of original data was generated on a clinically oriented basis. RESULTS Chronic ureteral obstruction can be classified into compression that is either intrinsic or extrinsic to the ureteral wall, or obstruction that is of a benign or malignant origin. Patients with malignant ureteral obstruction generally have a poor prognosis and are often difficult to treat. The aim of stenting is to adequately drain the upper urinary tracts while minimizing hospitalization and the negative impact on quality of life. Facing the challenge of chronic ureteral obstruction, novel stents with new compositions, materials, coatings and designs have been developed. Metallic stents are emerging as efficacious and financially viable alternatives. Early stent related complications include iatrogenic injury, stent migration or patient discomfort, while late complications include infection, difficulties with stent exchange, hardware malfunction, infection and stent encrustation. CONCLUSIONS Stenting in chronic ureteral obstruction is a complex and challenging problem. Much work is being done in this area and many options are being explored.
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Affiliation(s)
- Julia Fiuk
- Division of Urology, Southern Illinois University School of Medicine, Springfield, Illinois
| | - Yige Bao
- Division of Urology, Department of Surgery and Department of Microbiology and Immunology, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada; Department of Urology, West China Hospital, Sichuan University, West China School of Clinical Medicine, Sichuan University, Chengdu, China
| | - John G Calleary
- Department of Urology, North Manchester General Hospital, Manchester, United Kingdom
| | - Bradley F Schwartz
- Division of Urology, Southern Illinois University School of Medicine, Springfield, Illinois
| | - John D Denstedt
- Division of Urology, Southern Illinois University School of Medicine, Springfield, Illinois.
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30
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Patel D, Kumar A, Ranganath P, Contractor S. Endovascular treatment of arterio-ureteral fistulae with covered stents: Case series and review of the literature. SAGE Open Med Case Rep 2014; 2:2050313X14548094. [PMID: 27489652 PMCID: PMC4857363 DOI: 10.1177/2050313x14548094] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Accepted: 07/24/2014] [Indexed: 11/16/2022] Open
Abstract
Arterio-ureteral fistulae are abnormal connections between an artery and the ureter and carry a high mortality. We present two cases of arterio-ureteral fistulae that presented with life-threatening hematuria. Both patients were treated with endovascular covered stent placement.
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Affiliation(s)
- Dhruv Patel
- Department of Radiology, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Abhishek Kumar
- Department of Radiology, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Praveen Ranganath
- Department of Radiology, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Sohail Contractor
- Department of Radiology, Rutgers New Jersey Medical School, Newark, NJ, USA
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31
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Dormeus S, Hernández EA, Nicolazzi M, Barba JF, Algarra R, Tienza A, Pascual JI, Berián JM, Zudaire JJ. Ureteroiliac fistula secondary to radiotherapy in a patient with single renal metastasis of colon adenocarcinoma. Can Urol Assoc J 2013; 7:E146-9. [PMID: 23671507 DOI: 10.5489/cuaj.259] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
We report the case of a 61-year-old man diagnosed in 2001 with rectal cancer (stage T3N1M0). The patient was treated with surgery, adjuvant chemotherapy and radiotherapy. In 2009, he was admitted to the urology department with a complaint of right hemiabdominal pain. The anatomopathological investigation reported renal metastasis of colon adenocarcinoma. After surgery, he received adjuvant chemotherapy. No tumour recurrence or metastasis was reported at the 22-month follow-up.
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32
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Tselikas L, Pellerin O, Di Primio M, Ben Arfi M, Joskin J, Beyssen B, Thiounn N, Sapoval M. Uretero-iliac fistula: Modern treatment via the endovascular route. Diagn Interv Imaging 2013; 94:311-8. [DOI: 10.1016/j.diii.2012.10.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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33
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Abstract
The pelvic course of the ureter with its close proximity to the iliac artery, pelvic viscera, and other structures predispose to fistula formation. Surgical management of lower urinary tract fistulas is difficult and often ineffective. Nonvascular lower urinary tract fistulas can be managed by urinary diversion with percutaneous nephrostomy to allow for fistula healing. If this fails, ureteral embolization can be very effective; however, this should be preceded by careful evaluation and discussion with the patient as this intervention results in irreversible ureteral occlusion necessitating a diverting nephrostomy catheter indefinitely. A ureteroarterial fistula is a distinct entity compared with nonvascular fistulas with a different approach to management; it can be managed by exclusion of the fistula by endovascular placement of a stent graft across the arterial component of the fistula.
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Affiliation(s)
- Radha Popuri
- Section of Vascular and Interventional Radiology, Mallinckrodt Institute of Radiology, St. Louis, Missouri
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Okada T, Yamaguchi M, Muradi A, Nomura Y, Uotani K, Idoguchi K, Miyamoto N, Kawasaki R, Taniguchi T, Okita Y, Sugimoto K. Long-term Results of Endovascular Stent Graft Placement of Ureteroarterial Fistula. Cardiovasc Intervent Radiol 2012. [DOI: 10.1007/s00270-012-0534-6] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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A primary arterial-ureteral fistula after an aortic-bifemoral bypass. Int J Surg Case Rep 2012; 4:48-50. [PMID: 23123414 DOI: 10.1016/j.ijscr.2012.09.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2012] [Accepted: 09/28/2012] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Primary arterial-ureteral fistula is a rare and diagnostically challenging condition which may present with massive hematuria. PRESENTATION OF CASE A case of primary arterial-ureteral fistula (AUF) is presented in a patient with a previous prosthetic aortic-bifemoral bypass. The AUF treated with arterial and ureteral resection, arterial ligation and ureteral reconstruction. DISCUSSION Primary AUF are more frequently associated with aneurysmal degeneration of the arterial wall. The development of a primary fistula due to an iliac artery aneurysm many years after an aortic-bifemoral bypass performed due to atherosclerotic obstructive disease is a very unusual presentation of this entity. Multiple surgical strategies can be employed in achieving hemorrhage and infection control, urinary tract continuity, and vascular reconstruction. CONCLUSION A multidisciplinary approach and the achievement of a pre-operative diagnosis are essential for an effective management of this condition with prognostic implications.
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Hori S, Thiruchelvam N. Life-threatening hematuria due to recurrent arterial-conduit fistula. Urology 2011; 79:23-7. [PMID: 22000929 DOI: 10.1016/j.urology.2011.08.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2011] [Revised: 07/29/2011] [Accepted: 08/13/2011] [Indexed: 10/16/2022]
Affiliation(s)
- Satoshi Hori
- Department of Uro-Oncology, University of Cambridge, Hutchison/MRC Research Centre, and Department of Urology, Addenbrooke's Hospital, Cambridge, United Kingdom.
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Ureteroarterial Fistula Treatment With Open Surgery Versus Endovascular Management: Long-Term Outcomes. J Urol 2011; 185:945-50. [DOI: 10.1016/j.juro.2010.10.062] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2010] [Indexed: 12/16/2022]
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Endovascular treatment of a right-sided ureteroiliac fistula in a patient with a simultaneous left-sided ureteroileal fistula. Case Rep Urol 2011; 2011:284505. [PMID: 22606609 PMCID: PMC3350230 DOI: 10.1155/2011/284505] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2011] [Accepted: 06/21/2011] [Indexed: 11/17/2022] Open
Abstract
We describe an 80-year-old female with a left ureteroileal fistula and simultaneously a right ureteroiliac fistula. Her history highlights the predisposing factors of radiation, major surgery in the region, and presence of bilateral double-J-stents. She was successfully treated with an endovascular approach after being initially misdiagnosed. There seems to be an increase in reporting ureteral fistulas, however this entity remains a rare clinical condition that can lead to life-threatening situations. A fast and accurate diagnosis of an ureteroarterial fistula remains a challenge.
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Uretero-iliac artery fistula: a diagnostic and therapeutic challenge. Adv Urol 2010:276497. [PMID: 20467474 PMCID: PMC2866967 DOI: 10.1155/2010/276497] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2010] [Accepted: 02/18/2010] [Indexed: 11/17/2022] Open
Abstract
Uretero-Iliac artery fistulas (UAFs) are very uncommon in urological practice. The rarity of this clinical entity may lead to a delayed or missed diagnosis which can result in life-threatening consequences. We present a case of a right ureteric and right external iliac artery fistula, its presentation, diagnosis, and management along with the review of the literature.
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Ureteroiliac artery fistula in a young woman with short bowel syndrome for radiation enteritis. Case Rep Med 2010; 2010:287034. [PMID: 20300556 PMCID: PMC2838412 DOI: 10.1155/2010/287034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2010] [Accepted: 02/23/2010] [Indexed: 12/25/2022] Open
Abstract
Ureteral-iliac artery fistula is a rare and potentially life-threatening complication, typically occurring after radiation therapy in already surgically treated cancer patients. This case report describes the diagnostic challenges and the successful management, with the positioning of an intra-arterial prosthesis, of a fistula between the internal iliac artery and the left ureter presenting as massive hematuria in a young woman with history of total colectomy and pelvic radiotherapy for rectal cancer and subsequent wide ileal resections and bilateral ureteral stent positioning for radiation enteritis. Ureteroiliac artery fistulas require a prompt diagnosis and intervention, to avoid life threatening clinical events.
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Abstract
Ureteral arterial fistula (UAF) is an uncommon condition but one that has been increasing with over 100 cases reported. The presentation is gross hematuria in a patient with predisposing factors, such as prior pelvic surgery, past radiation therapy, and chronic ureteral stenting. When not correctly diagnosed, the associated mortality is significant. Diagnosis is best accomplished by careful angiography with frequent use of provocative maneuvers. The current best therapeutic option is sealing off the UAF by deploying a stent graft in the artery.
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Affiliation(s)
- Michael Darcy
- Department of Radiology, Mallinckrodt Institute of Radiology, Washington University in St Louis, St Louis, MO 63110, USA.
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Yamasaki K, Omori K, Takaoka EI, Sekido N, Shigai M, Mori K, Minami M, Watanabe Y, Shimazui T, Akaza H. Successful Management by Provocative Angiography and Endovascular Stent of Ureteroarterial Fistula in a Patient with a Long-term Indwelling Ureteral Stent. Jpn J Clin Oncol 2009; 40:267-70. [DOI: 10.1093/jjco/hyp154] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Current world literature. Curr Opin Obstet Gynecol 2009; 21:450-5. [PMID: 19724169 DOI: 10.1097/gco.0b013e3283317d6c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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van den Bergh RC, Moll FL, de Vries JPP, Lock TM. Arterioureteral Fistulas: Unusual Suspects—Systematic Review of 139 Cases. Urology 2009; 74:251-5. [DOI: 10.1016/j.urology.2008.12.011] [Citation(s) in RCA: 78] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2008] [Revised: 11/26/2008] [Accepted: 12/01/2008] [Indexed: 12/14/2022]
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