Fatal Recurrent Ureteroarterial Fistulas after Exenteration for Cervical Cancer

Endovascular management and the risk of late failure in the treatment of ureteroarterial fistulas

“…Flank or back pain secondary to ureter distention has also been described 11 . Risk factors of UAF include pelvic surgery, radiation therapy, chronic ureteral stents1, 12 (with chronic ureteral stents being the most common in 73.7% of patients 7 ), and history of malignant disease (cervical, bladder, and colorectal). Abdominal and pelvic operations were reported in 69.5% of patients, including urinary diversion in 30% of patients.…”

“…The patients described herein had many of these risk factors. Angiography can diagnose UAF and allow rapid deployment of an endovascular stent graft with or without coil embolization of the affected vasculature, 12 and cystoscopy can determine laterality of the UAF 7 by showing which ureteral orifice from the bladder is bleeding. Ureteroscopy allows direct visualization of the lesion.…”

Ureteroarterial fistulas after radical pelvic surgery: pathogenesis, diagnosis, and therapeutic modalities

“…In 2001, DePasquale et al reported a classic nonvascular case of UAF. The patient was treated with primary open surgical treatment without the benefit of preoperative diagnosis (18) . Although vascular surgery initially resulted in patient stabilization, the fistula recurred and resulted in death of the patient.…”

“…However, the patients with UAF of nonvascular etiology may benefit from a less invasive approach; Gheiler et al (7) in 1998 reviewed 43 reported cases. Twenty involved a fistula (18) . Although vascular surgery initially resulted in patient stabilization, the fistula recurred and resulted in death of the patient.…”

Ureteroarterial Fistula with Ruptured Anastomotic Pseudoaneurysm: Successful Management with Vascular Exclusion, Extra-anatomic Bypass and Nephrectomy

“…Before the 1970s, the mortality rate was reported to be 64% with the majority of diagnoses made postmortem or after unsuccessful nephrec-tomy. 1 More recently, advances in critical care and diagnostic modalities have allowed for hemodynamic stabilization and earlier diagnosis. Nonetheless, the contemporary mortality rate from ureteroarterial fistula remains about 40%.…”