Uretero-arterial fistula: Six new cases and systematic review of the literature

Ghouti, C.; Léon, Grégoire; Seddik, S.; Said, Khelifa Ait; Vaudreuil, Lionel; Tillou, X.

doi:10.1016/j.purol.2020.12.015

Cited by 2 publications

(2 citation statements)

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“…UAF usually involves left common iliac artery, but can also incorporate aorta, external or internal iliac vessels [ 4 , 8 , 10 , 11 ]. Although the reported mortality rate has recently decreased mainly to endovascular treatments, UAF remains a potentially life-threatening condition, especially in cases with large fistulas and delayed treatment [ 6 , 7 , 8 ].…”

Section: Discussionmentioning

confidence: 99%

“…UAF incidence is increasing due to improved survival after aggressive management of pelvic tumors that involves large surgical resections, urinary diversions and radiotherapy [ 5 , 7 , 8 ]. Diagnostic pathways and treatments are very heterogeneous, since most of the published articles are limited to case series or reports [ 1 , 9 , 10 , 11 ].…”

Section: Introductionmentioning

confidence: 99%

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Challenges in Diagnosis of Uretero–Arterial Fistulas after Complex Pelvic Oncological Procedures—Single Center Experience and Review of the Literature

et al. 2022

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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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