Arterioureteral fistula after radical cystectomy and ureterocutaneostomy: two case reports and a systematic literature review

Abstract

Background Arterioureteral fistula (AUF) is a rare, life-threatening condition wherein communication occurs between a ureter and the common, internal, or external iliac artery. The sensitivity of common clinical imaging examination for AUF is low, which leads to a delayed diagnosis and increased mortality. In addition, the increased use of ureteral stents contributes to the growing frequency of AUF. Case presentation Our two patients were 74 and 65 years old males respectively. They both had a medical history of bladder cancer and underwent radical cystectomy with ureterocutaneostomy. The patients underwent routine catheter exchange during over 1 year postradical cystectomy and subsequently experienced intermittent gross pulsatile haematuria. After a series of imaging examinations failed to identify the cause, the patients were ultimately diagnosed with AUF and treated with interventional radiotherapy, followed by broad-spectrum antibiotics. Positive effects were found. Conclusions The incidence of AUF is increased with the prolongation of survival in patients with related risk factors. This case report aims to highlight early diagnosis and management of AUF to lower the mortality.

Silent arterio-ureteral fistula: Diagnosis and endovascular management

“…Patients with a history of pelvic malignancy such as our patient usually are subjected to these risk factors raising their risk for AUF. 1 Radiation causes ischemic injury to the arterial wall by damaging the vasa vasorum of the iliac artery or aorta, and the severity of the ischemic injury is dose-dependent. 6 Additionally, many of these patients are receiving anticancer treatments that hinder the body's natural healing processes.…”

“…The growing prevalence of ureteral stents usage is also contributing to the rising occurrence of AUFs. 1 The symptoms of AUFs are often vague and can resemble the presentation of other urological or vascular disorders, making the diagnosis challenging. Contrast-enhanced computed tomography (CT) can detect various useful findings such as extravasation, pseudoaneurysms, hydronephrosis, and opacification of ureters, which suggest the presence of AUF.…”

Ureteroarterialis fisztula – Esetbemutatás

“…A kezdeti tünetek nem specifikusak és jelenlétük akár átmeneti is lehet a kivizsgálás során. Az elsőként jelentkező, úgynevezett bevezető tünetek a haematuria, illetve a lágyéktáji fájdalom, vagy a kettő együttesen (1,5,7). A leggyakoribb kezdeti tünet a haematuria, amely az esetek 99%-ában van jelen (8).…”

“…További ismételt intervenciót igénylő szövődmény a visszatérő haematuria (10-14%-ban fordul elő, mortalitása 50%), az endoleak, illetve a graftinfekció (1,8). Az infekció, mint veszélyes szövődmény felveti a profilaktikus antibiotikumterápia bevezetésének kérdését, ám erre vonatkozó irányelv nem áll rendelkezésre (3,6,7,8,10,11). A beavatkozást követően leírtak iszkémiás bőrulcerációt, ipsilateralis mélyvénás trombózist, krónikus lábfájdalmat, valamint femurfej-oszteonekrózist.…”

Delayed right external iliac artery disruption after radical cystectomy: A case report and literature review

“…Vascular complications, such as intraoperative injury to blood vessels, which results in massive bleeding, are commonly reported complications of radical cystectomy, which is a catastrophic event and may potentially have an unfavorable effect on surgical mortality rates ( 4 , 5 ). Iliac artery pseudoaneurysm and arterioureteral fistula are rare complications following radical cystectomy ( 6 , 7 ). The present study described another rare case of delayed right external iliac artery disruption that occurred one month after laparoscopic radical cystectomy, without any obvious evidence of iliac artery pseudoaneurysm or arterioureteral fistula.…”