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Ongaro L, Rizzo M, Claps F, Runti O, Piasentin A, Trombetta C, Liguori G. Arterioureteral fistula: An unusual cause of haematuria 10 years after the implantation of a synthetic iliac-femoral stent. Asian J Urol 2023; 10:563-564. [PMID: 38024425 PMCID: PMC10659961 DOI: 10.1016/j.ajur.2022.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Indexed: 12/12/2022] Open
Affiliation(s)
- Luca Ongaro
- Department of Urology, Cattinara Hospital, ASUGI, University of Trieste, Trieste, Italy
| | - Michele Rizzo
- Department of Urology, Cattinara Hospital, ASUGI, University of Trieste, Trieste, Italy
| | - Francesco Claps
- Department of Urology, Cattinara Hospital, ASUGI, University of Trieste, Trieste, Italy
| | - Ottavia Runti
- Department of Urology, Cattinara Hospital, ASUGI, University of Trieste, Trieste, Italy
| | - Andrea Piasentin
- Department of Urology, Cattinara Hospital, ASUGI, University of Trieste, Trieste, Italy
| | - Carlo Trombetta
- Department of Urology, Cattinara Hospital, ASUGI, University of Trieste, Trieste, Italy
| | - Giovanni Liguori
- Department of Urology, Cattinara Hospital, ASUGI, University of Trieste, Trieste, Italy
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Ohta R, Inoue K, Sano C. Fatal Bleeding From a Common Iliac Arterio-Ureteral Fistula in an Older Patient. Cureus 2022; 14:e21578. [PMID: 35228937 PMCID: PMC8873314 DOI: 10.7759/cureus.21578] [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: 01/24/2022] [Indexed: 11/05/2022] Open
Abstract
Fatal ureteral bleeding is rare among elderly individuals. One cause of bleeding can be a fistula between the arteries and urinary organs, such as a common iliac arterio-ureteral fistula. However, the clinical presentation of fistulas can vary. As microscopic hematuria can be an initial finding, detecting the fistula without gross hematuria may be difficult. Here, we report a case of microhematuria that progressed to massive hematuria caused by a common iliac arterio-ureteral fistula. The patient was an 86-year-old man with a chief complaint of cardiopulmonary arrest. He was resuscitated in the previous condition. He had microscopic hematuria. One month later, the patient underwent rehabilitation. He was in hemorrhagic shock with massive hematuria. Further investigation revealed a right common iliac arterio-ureteral fistula. This case demonstrates the importance of investigating anemia in the elderly, including anemia of urinary origin, despite it being rare.
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Brown KR, Jean-Claude JM, Rilling WS, Donnell RF, Seabrook GR, Towne JB, Cambria RA. Arterioureteral Fistula. ACTA ACUST UNITED AC 2016. [DOI: 10.1177/153857440003400508] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Arterioureteral fistula is a rare clinical entity that has been reported more frequently over the past decade. The risk factors for arterioureteral fistula include previous pelvic or urologic surgery, ureteral stenting, pelvic irradiation, and previous vascular pathology. All patients who present with this clinical entity have at least one of these risk factors, and the majority of patients have more than one risk factor. Radiographic demonstration of an arterioureteral fistula may be difficult and often requires more than one diagnostic modality. Angiography and retrograde ureterography appear to be the most helpful in establishing a diagnosis. The literature suggests that patients with a diagnosis of arterioureteral fistula before surgery have an increased incidence of renal salvage and decreased mortality. Methods of repair have been varied, but in the past several years, endovascular approaches to this problem have become more common. The authors report two cases of arterioureteral fistulae, one managed operatively, and one managed by endovascular placement of a covered stent. The literature is reviewed, and etiology, diagnosis, surgical therapy, and endovascular therapy are discussed.
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Affiliation(s)
| | | | - William S. Rilling
- Department of Interventional Radiology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Robert F. Donnell
- Department of Urology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | | | | | - Robert A. Cambria
- Department of Vascular Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
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Bilateral Ureteral-Iliac Artery Fistula in a Patient with Chronic Indwelling Ureteral Stents: A Case Report and Review. Case Rep Urol 2015; 2015:826760. [PMID: 26075136 PMCID: PMC4436465 DOI: 10.1155/2015/826760] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Accepted: 04/25/2015] [Indexed: 12/14/2022] Open
Abstract
Ureteral-arterial fistula (UAF) is an exceedingly rare but life-threatening condition warranting emergent intervention. Prompt recognition and management of UAF in suspect patients presenting with gross hematuria are required for a successful outcome. We report a rare subset of UAF involving the bilateral common iliac arteries. The patient underwent successful endovascular stent-grafting to correct the arterial defect and delayed open repair of the ureteral strictures. Timely management has benefited from the collaboration of the involved medical teams, which included emergency medicine, urology, and interventional radiology.
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Abstract
Ureteral-iliac artery fistula (UIAF) is a rare life threatening cause of hematuria. The increasing frequency is attributed to increasing use of ureteral stents. A 68-year-old female presented with gross hematuria. She had prior low anterior resection for rectal cancer and a retained ureteral stent. CT abdomen and pelvis showed a large recurrent pelvic mass and a retained stent. The patient underwent cystoscopy which showed a normal bladder. Upon removal of the stent, brisk bleeding was noted coming from the ureteral orifice. Antegrade pyelogram was done which revealed a UIAF. Angiography was done and a covered stent was placed. Multiple treatment options are available. All must consider management of the arterial and ureteral side. The arterial side may be addressed by primary open repair, embolization with extra-anatomic vascular reconstruction, or endovascular stenting. The ureter can be managed with nephroureterectomy, ureteral reconstruction, placement of a nephrostomy tube, or ureteral stenting. Being minimally invasive, we believe that endovascular stenting should be the preferred therapeutic option as it also corrects the source of bleeding while preserving distal blood flow.
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Araki T, Nagata M, Araki T, Takihana Y, Takeda M. Endovascular treatment of ureteroarterial fistulas with stent-grafts. ACTA ACUST UNITED AC 2008; 26:372-5. [DOI: 10.1007/s11604-008-0235-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2007] [Accepted: 02/12/2008] [Indexed: 11/28/2022]
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ESCOBAR P, HOWARD J, KELLY J, ROLAND P, GRENDYS E, DOSORETZ D, ORR J. Ureteroarterial fistulas after radical pelvic surgery: pathogenesis, diagnosis, and therapeutic modalities. Int J Gynecol Cancer 2008; 18:862-7. [DOI: 10.1111/j.1525-1438.2007.01079.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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8
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Krautschick-Wilkens AW, Kahle S, Teichmann M, Stolle H. [Iliac ureteral fistulas. Diagnosis and management of an increasing problem]. Urologe A 2005; 45:183-5, 187-8. [PMID: 16341511 DOI: 10.1007/s00120-005-0979-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Iliac-ureteral fistulas (IUF) are a rare but potential life threatening event and an important cause of gross hematuria. We report on three cases of IUF. In all cases, prior chronic ureteral stenting, extended pelvic surgery or pelvic irradiation had been performed. Diagnosis was confirmed with angiography in one case, in the others a CT scan revealed the IUF. Treatment included surgical exploration with local reconstruction, extra-anatomical bypass and nephrectomy with arterial patch repair. The increasing incidence of IUF is a consequence of an increasing number of advanced and extended pelvic operations, radiation therapy and long-term ureteral stenting. Diagnosis should be made by provocative angiography or CT. Treatment options vary depending on the site and morphology of the local situation, but morbidity and mortality is still high due to delayed adequate diagnosis and treatment. A conclusive algorithm should be followed for the successful management of IUF.
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Krambeck AE, DiMarco DS, Gettman MT, Segura JW. Ureteroiliac artery fistula: Diagnosis and treatment algorithm. Urology 2005; 66:990-4. [PMID: 16286109 DOI: 10.1016/j.urology.2005.05.036] [Citation(s) in RCA: 103] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2005] [Revised: 04/26/2005] [Accepted: 05/13/2005] [Indexed: 12/11/2022]
Abstract
OBJECTIVES To review the diagnosis and treatment of ureteroarterial fistulas and to develop a management algorithm. Long-term ureteral stenting, along with pelvic surgery and radiotherapy, have led to an increased incidence of ureteroarterial fistulas. Experience diagnosing and treating these fistulas has been limited to case reports. METHODS A retrospective chart review from 1975 to 2004 revealed eight ureteroarterial fistulas in 7 patients at our institution. The patient demographics, presenting symptoms, and diagnostic studies were reviewed. Also, we analyzed the treatment, hospital course, and long-term outcomes. RESULTS Ureteroarterial fistulas were more common in women (86%) than in men. All patients presented with gross hematuria, and 57% had lateralizing flank pain. Risk factors included chronic indwelling stents (87%), previous pelvic external beam radiotherapy (71%), pelvic surgery (100%), and vascular disease (87%). Provocative angiography was diagnostic in only 63% of cases. Although not sensitive, cystoscopy revealed lateralized, pulsatile hematuria in all cases when performed. Treatment ranged from endovascular stenting with nephrostomy tube to primary surgical repair with nephrectomy. CONCLUSIONS On the basis of this review, we propose a systematic diagnostic and treatment approach to a serious disease process. The use of these proposed algorithms will minimize unnecessary testing, increase the speed of diagnosis, and potentially improve overall outcomes of patients with ureteroarterial fistulas.
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Affiliation(s)
- Amy E Krambeck
- Department of Urology, Mayo Clinic, Rochester, Minnesota 55905, USA.
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Ferrante A, Manni R, Giustacchini M, Cotroneo A, Snider F. Arterioureteric Fistula: Successful Treatment of Two Cases. Eur J Vasc Endovasc Surg 2004; 28:559-61. [PMID: 15465380 DOI: 10.1016/j.ejvs.2004.06.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/07/2004] [Indexed: 11/18/2022]
Affiliation(s)
- A Ferrante
- Department of Cardiovascular Medicine, Vascular Surgery Unit, Catholic University School of Medicine A.Gemelli, Rome, Italy.
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Madoff DC, Gupta S, Toombs BD, Skolkin MD, Charnsangavej C, Morello FA, Ahrar K, Hicks ME. Arterioureteral Fistulas: A Clinical, Diagnostic, and Therapeutic Dilemma. AJR Am J Roentgenol 2004; 182:1241-50. [PMID: 15100126 DOI: 10.2214/ajr.182.5.1821241] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- David C Madoff
- Division of Diagnostic Imaging, The University of Texas M D Anderson Cancer Center, 1515 Holcombe Blvd., Unit 325, Houston, TX 77030, USA
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Marco Pérez LM, Vigués Julia F, Trilla Herrera E, Domínguez Elias J, Ponce Campuzano A, González Satué C, Aguiló Lucia F, Serrallach i Milá N. [Hematuria secondary to arterioureteral fistula. Endovascular treatment]. Actas Urol Esp 2001; 25:668-71. [PMID: 11765553 DOI: 10.1016/s0210-4806(01)72695-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Presentation of case of patient with macroscopic anemic hematuria caused for the presence of a fistula between the external iliac artery and the ureter. After the diagnosis, a treatment with endovascular mangement was made. The arterioureteral fistulae are a very rare entie, which supposes a vital emergency. The diagnosis depend upon the clinical evidences (complementary explorations rarely provide specific findings). Classic treatment is bases on open surgery, while endovascular treatment may be an alternative with less aggressiveness.
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Affiliation(s)
- L M Marco Pérez
- Servicio de Urología, Ciutat Sanitaria i Universitaria de Bellvitge, L'Hospitalet de Llobregat, Barcelona
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Abstract
OBJECTIVE To review published reports on arterio-ureteral fistula. METHOD Literature search. RESULTS Eighty cases were identified. Primary fistulas were mainly seen in combination with aortoiliac aneurysmal disease. Secondary fistulas were seen after pelvic cancer surgery, often with radiation, fibrosis and ureteral stenting or after vascular surgery with synthetic grafting. The dominating symptom is massive haematuria, often with circulatory impairment. The clue to a rapid and correct diagnosis is a high degree of suspicion. Most frequently diagnosis has been obtained through angiography or pyelography. When there is a ureteral stent manipulation it will often provoke bleeding and lead to diagnosis. The fistula must be excluded and a vascular reconstruction made. Most frequently this has been obtained through occlusion of the fistula and an extra-anatomic reconstruction (femoro-femoral crossover). Recently stent-grafting has been successfully used but follow-up is short. CONCLUSION Arterio-ureteral fistula is rare and should be suspected in patients with complicated pelvic surgery and massive haematuria, especially where rigid ureteral stents have been placed.
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Affiliation(s)
- D Bergqvist
- Department of Surgical Sciences, Section of Surgery & Section of Urology, Uppsala, Sweden
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