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Arterio-ureteral fistula--a systematic review
D Bergqvist1, H Pärsson, A Sherif
1Department of Surgical Sciences, Section of Surgery & Section of Urology, Uppsala, Sweden.
Summary
Arterio-ureteral fistula is a rare condition, often linked to pelvic surgery or vascular procedures. High suspicion is key for diagnosis, particularly in patients with massive hematuria and ureteral stents.
Area of Science:
- Urology
- Vascular Surgery
- Medical Case Review
Background:
- Arterio-ureteral fistula (AUF) is a rare but serious complication.
- It can arise primarily with aortoiliac aneurysms or secondarily after pelvic surgery or vascular interventions.
Purpose of the Study:
- To review and synthesize published reports on arterio-ureteral fistula.
- To highlight diagnostic challenges and treatment strategies for AUF.
Main Methods:
- Comprehensive literature search of published case reports.
- Analysis of identified cases focusing on etiology, presentation, diagnosis, and management.
Main Results:
- Eighty cases of AUF were identified.
- Primary AUF associated with aortoiliac aneurysms; secondary AUF linked to pelvic cancer surgery (with radiation/stenting) or vascular surgery (synthetic grafts).
- Massive hematuria and circulatory compromise are key symptoms; diagnosis often requires angiography/pyelography, sometimes prompted by ureteral stent manipulation.
Conclusions:
- AUF is rare and necessitates a high index of suspicion in patients presenting with massive hematuria post-pelvic surgery, especially with ureteral stenting.
- Prompt diagnosis and exclusion of the fistula followed by vascular reconstruction (e.g., femoro-femoral crossover or stent-grafting) are crucial for management.