Schneider M H, Laturnus J M, Cordes J
Klinik und Poliklinik für Urologie, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Deutschland.
Urologe A. 2019 Jun;58(6):666-672. doi: 10.1007/s00120-019-0923-4.
Arterioureteral fistulas are rare, life-threatening, and difficult to diagnose. Risk factors are medical interventions in the lesser pelvis (general, urological, gynecological, and vascular surgery), radiation therapy of the lesser pelvis, permanent double J catheters, and previous vessel malformations.
We retrospectively evaluated all cases of arterioureteral fistulas registered over the last 10 years in the clinic's documentation system. For all cases, clinical symptoms, diagnostics, therapies as well as clinical outcome were evaluated.
Four of the 5 patients were women. The most common initial symptom was a gross hematuria (4/5). All patients had a permanent double J catheter after extensive surgery of the lesser pelvis. In one case the initial diagnosis was done by retrograde ureterography, in 2 patients by provocative angiography and in the other 2 cases with a laparotomy due to cardiovascular problems. Three patients were treated by open surgery and 2 patients were treated by stenting of the iliac artery. One patient died, 2 patients had a permanent kidney fistula, and 2 patients continued treatment with a permanent double J catheter.
Based on the more aggressive therapy regimens, we expect that the number of patients presenting with arterioureteral fistulas will continue to rise. The identification of these patients based on their risk profile is essential.
动脉输尿管瘘罕见、危及生命且难以诊断。危险因素包括盆腔内的医学干预（普通外科、泌尿外科、妇科和血管外科手术）、盆腔放疗、永久性双J管以及既往血管畸形。
我们回顾性评估了过去10年在该诊所文档系统中登记的所有动脉输尿管瘘病例。对所有病例的临床症状、诊断、治疗以及临床结局进行了评估。
5例患者中有4例为女性。最常见的初始症状是肉眼血尿（4/5）。所有患者在盆腔广泛手术后均留置了永久性双J管。1例患者通过逆行输尿管造影进行初始诊断，2例通过激发性血管造影，另外2例因心血管问题行剖腹探查术。3例患者接受开放手术治疗，2例患者接受髂动脉支架置入术。1例患者死亡，2例患者有永久性肾瘘，2例患者继续使用永久性双J管治疗。
基于更积极的治疗方案，我们预计动脉输尿管瘘患者的数量将持续上升。根据风险特征识别这些患者至关重要。
