Prontera Pier Paolo, Sciorio Carmine, De Cillis Antonio, Martinelli Evangelista, Schiralli Francesco, Lattarulo Marco, D'Elia Angelo, Utano Emanuele, Grossi Francesco Saverio
Department of Urology, "S.S. Annunziata" Hospital, Taranto.
Department of Urology, "Alessandro Manzoni" Hospital, Lecco.
Arch Ital Urol Androl. 2023 Feb 22;95(1):10928. doi: 10.4081/aiua.2023.10928.
Arterio-ureteralfistula (AUF) is an infrequent but potentially life-threatening condition. The aim of this study was reviewing the literature to build a flow-chart useful for an early and effective diagnosis and treatment of this pathology.
A literature search in PubMed was conducted. In addition, retrieved articles were cross-referenced. Data parameters included oncologic, vascular and urological history, diagnostics, treatment, and follow up were collected using a standard template by 2 independent reviewers.
A total of 140 cases of AUF out of 172 available in the literature at the time of the review, were considered. All patients presented gross hematuria. Chronic indwelling ureteral catheter (CIUC); history of pelvic surgery (HPS) and history of pelvic radiotherapy (HRT) were present respectively in 81%, 62.1%and 58.6% of the sample. The most predominant location of AUF was at the common iliac artery ureteral crossing. Angiography with provocative measures had the highest diagnostic sensitivity (50%) and endovascular treatment with stent-graft placement across the fistula is the current state of the art treatment choice.
Failure to diagnose can postpone a potentially life-saving targeted therapy and lead to complications. The identifi-cation of the Trifecta hematuria, history of pelvic surgery (HPS) and history of pelvic radiotherapy (HPR) would allow the identity-fication of patients at high risk of AUF, who may benefit from more sensitive early diagnostic investigations such as CT angiography and provocative angiography. The treatment of choice in case of AUF to date consist in endovascular prosthesis placement.
动脉输尿管瘘（AUF）是一种罕见但可能危及生命的疾病。本研究的目的是回顾文献，构建一个有助于早期有效诊断和治疗该疾病的流程图。
在PubMed上进行文献检索。此外，对检索到的文章进行交叉引用。数据参数包括肿瘤、血管和泌尿外科病史、诊断、治疗及随访，由2名独立审阅者使用标准模板收集。
在综述时，文献中172例AUF病例中有140例被纳入研究。所有患者均出现肉眼血尿。样本中分别有81%、62.1%和58.6%的患者存在慢性留置输尿管导管（CIUC）、盆腔手术史（HPS）和盆腔放疗史（HRT）。AUF最主要的位置是在髂总动脉输尿管交叉处。激发性血管造影的诊断敏感性最高（50%），目前治疗的首选方法是通过瘘口放置支架移植物进行血管内治疗。
未能诊断可能会推迟潜在的挽救生命的靶向治疗并导致并发症。识别三联征血尿、盆腔手术史（HPS）和盆腔放疗史（HPR）可确定AUF高危患者，这些患者可能受益于更敏感的早期诊断检查，如CT血管造影和激发性血管造影。迄今为止，AUF的治疗选择是血管内放置假体。
