Hendrik Heers1, Christopher Netsch2, Konrad Wilhelm3, Armin Secker4, Florian Kurtz5, Philipp Spachmann6, Simon Viniol7, Rainer Hofmann1, Axel Hegele1. 1. 1 Department of Urology and Paediatric Urology, Philipps-Universität Marburg , Marburg, Germany . 2. 2 Department of Urology, Asklepios Klinik Barmbek , Hamburg, Germany . 3. 3 Department of Urology, Albert-Ludwigs-Universität Freiburg , Freiburg, Germany . 4. 4 Department of Urology, Westfälische Wilhelms-Universität Münster , Münster, Germany . 5. 5 Department of Urology, Technische Universität München , Munich, Germany . 6. 6 Department of Urology, Krankenhaus St. Josef, University of Regensburg , Regensburg, Germany . 7. 7 Department of Diagnostic and Interventional Radiology, Philipps-Universität Marburg , Marburg, Germany .
Abstract
INTRODUCTION: Arterioureteral fistula (AUF) is a rare but potentially life-threatening disease that primarily arises as a long-term complication in oncological patients who have permanent ureteral stenting. The incidence is rising. The objective of this study was to outline the risk factors for management and outcome of AUF in a large individual case series. PATIENTS AND METHODS: Twenty-six AUF cases in 24 patients from six German tertiary referral centers occurring between 2008 and 2016 were identified retrospectively and entered into a dedicated database by using patient notes and out-patient visits. RESULTS: Of 24 patients, 23 had a history of abdominopelvic surgery for oncological disease, 21/24 had undergone radiotherapy, and 23/24 had long-term ureteral stenting. All cases presented with visible hematuria, 11/26 at the time of a stent exchange. Blood transfusions were required in 92.3%, and intravenous inotropes were needed in 46.2%. Of 26 patients, 11 had flank pain. CT angiogram was positive in 35.7%. Angiography and endovascular fistula repair was performed in 88.5%, and the rest received open surgical repair. Mortality was 7.7%. Endovascular treatment was technically successful in 91.3%, and open surgery was successful in 3/4 cases. Recurrent AUF developed in 3/24 patients. Stent-related complications occurred in 15%. Vascular complications were common. Long-term survival was limited due to progression of the underlying malignant disease. CONCLUSION: AUF results in major hemorrhage and warrants time-efficient diagnosis and treatment. Awareness is key. When AUF is considered, interventional angiography should promptly be performed. Fistula detection can be improved by guidewire manipulation. Pre-interventional CT angiogram may be omitted due to low sensitivity. Endovascular repair with stenting and/or coiling is effective and safe.
INTRODUCTION: Arterioureteral fistula (AUF) is a rare but potentially life-threatening disease that primarily arises as a long-term complication in oncological patients who have permanent ureteral stenting. The incidence is rising. The objective of this study was to outline the risk factors for management and outcome of AUF in a large individual case series. PATIENTS AND METHODS: Twenty-six AUF cases in 24 patients from six German tertiary referral centers occurring between 2008 and 2016 were identified retrospectively and entered into a dedicated database by using patient notes and out-patient visits. RESULTS: Of 24 patients, 23 had a history of abdominopelvic surgery for oncological disease, 21/24 had undergone radiotherapy, and 23/24 had long-term ureteral stenting. All cases presented with visible hematuria, 11/26 at the time of a stent exchange. Blood transfusions were required in 92.3%, and intravenous inotropes were needed in 46.2%. Of 26 patients, 11 had flank pain. CT angiogram was positive in 35.7%. Angiography and endovascular fistula repair was performed in 88.5%, and the rest received open surgical repair. Mortality was 7.7%. Endovascular treatment was technically successful in 91.3%, and open surgery was successful in 3/4 cases. Recurrent AUF developed in 3/24 patients. Stent-related complications occurred in 15%. Vascular complications were common. Long-term survival was limited due to progression of the underlying malignant disease. CONCLUSION: AUF results in major hemorrhage and warrants time-efficient diagnosis and treatment. Awareness is key. When AUF is considered, interventional angiography should promptly be performed. Fistula detection can be improved by guidewire manipulation. Pre-interventional CT angiogram may be omitted due to low sensitivity. Endovascular repair with stenting and/or coiling is effective and safe.
Authors: Alexander Massmann; Peter Fries; Roushanak Shayesteh-Kheslat; Arno Buecker; Michael Stöckle; Christina Niklas Journal: J Vasc Surg Cases Innov Tech Date: 2020-04-14
Authors: Tycho M T W Lock; Kyara Kamphorst; Roderick C N van den Bergh; Frans L Moll; Jean-Paul P M de Vries; Rob T H Lo; Gérard A P de Kort; Rutger C G Bruijnen; Pieter Dik; Simon Horenblas; Laetitia M O de Kort Journal: World J Urol Date: 2022-01-22 Impact factor: 4.226