Ureteroiliac Artery Fistula Caused by a Metallic Memokath Ureteral Stent in a Radiation-Induced Ureteral Stricture

Abstract

Background: Memokath 051™ stents are increasingly used for management of benign and malignant ureteral strictures refractory to management with single or tandem polymeric Double-J ureteral stents. Migration, encrustation, and difficulty in extraction during stent exchange are the chief problems reported so far with these thermoexpandable metallic stents. We report an unusual complication of ureteroexternal iliac artery fistula (UEAF) caused by Memokath stent inserted for radiation-induced ureteral stricture.Case Presentation: A 71-year-old male with history of colorectal cancer (underwent extirpative surgery + chemoradiotherapy) and subsequently radiation-induced ureteral stricture had bilateral Memokath ureteral stents inserted. Three months later, he presented with sepsis and hemodynamic instability secondary to UEAF, confirmed on angiography. A covered vascular stent was inserted as an immediate management.Conclusion: Memokath stent insertion in radiation-induced ureteral strictures may be associated with an increased risk of erosion and the rare potential complication of UEAF. This potential risk needs to be considered in the overall setting of such strictures and the difficulty in treating them. Prompt imaging (angiography) and placement of an endovascular stent are the ideal immediate options in such cases.

Rekonstruktive Chirurgie des Ureters

“…Die Autoren erarbeiteten Risikofaktoren, die mit einer deutlich verkürzten Liegezeit der Stents verbunden waren: Niereninsuffizienz mit einer GFR < 60 ml/min/1.73 m 2 (317 versus 386 Tage, p < 0.01) und maligne Obstruktion (190 versus 455 Tage, p < 0.01). In einer weiteren großen, retrospektiven Studie haben Agrawal et al [44] Ähnlich der permanenten Harnableitung mit DJ-Kathetern kann auch der Memokath-Stent bei radiogener Striktur zu erheblichen Komplikationen bis hin zu uretero-iliakalen Fisteln führen [43].…”