Waqar Muhammad, Mathias Suresh-Jay, Murali Vinodh, Thursby Helen, Luscombe Christopher, James Ronald, Mak David, Chakravarti Aniruddha, Day Christopher, Dyer Jules
Urology, The Royal Wolverhampton NHS Trust, Wolverhampton, GBR.
Urology, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, GBR.
Cureus. 2023 Jun 5;15(6):e39989. doi: 10.7759/cureus.39989. eCollection 2023 Jun.
Arterioureteral fistula (AUF) is a direct communication between the ureter and an artery and is a rare cause of catastrophic, life-threatening haematuria. Fistulation may occur between the ureter and the abdominal aorta, common iliac, external and internal iliac, and inferior mesenteric arteries, and is typically observed in patients with a prior history of pelvic radiotherapy, oncological pelvic surgeries, aortoiliac vascular procedures, and pelvic exenteration. There is also an increased frequency of cases amongst patients who have undergone urological diversion surgeries and in those with chronic indwelling ureteric stents requiring repeated exchange. As AUF is so rarely encountered in clinical practice, the urologist may fail to appreciate its presence until late in the patient's presentation; such diagnostic delay is associated with high mortality and thus rapid clinical suspicion and investigative action are necessary. There are sporadic cases of this rare entity mentioned in literature. In this report, we present two cases as well as a review of the literature. A 73-year-old female presented with repeated episodic haematuria for a week in whom the cause of symptoms remained persistently elusive despite repeated imaging and operative approaches. An eventual diagnosis of a secondary right internal iliac-ureteral fistula was ascertained on a subsequent digital subtraction angiography of the renal tract. The fistula was embolised using an endovascular approach. The patient remained stable post emobilisation and was successfully discharged shortly after the procedure. In the second case, a 51-year-old female, presented with hematuria from her ileal conduit for a few days. Initially, the cause of symptoms was thought to be due to ureteric stents. During a change in her stents, brisk bleeding led to further investigation including an iliac angiogram confirming bleeding from the left common iliac artery. She had a covered common iliac artery stent, which successfully controlled her bleeding This report emphasizes the diagnostic difficulty of AUF, outlines the management principles of this rare disease, and aims to increase awareness of this rare yet potentially lethal phenomenon among practitioners of urology and interventional radiology.
动输尿管瘘（AUF）是输尿管与动脉之间的直接连通，是灾难性、危及生命的血尿的罕见原因。瘘管可能发生在输尿管与腹主动脉、髂总动脉、髂外动脉、髂内动脉和肠系膜下动脉之间，通常见于有盆腔放疗、肿瘤盆腔手术、主髂血管手术和盆腔脏器清除术病史的患者。在接受尿流改道术的患者以及需要反复更换慢性留置输尿管支架的患者中，病例发生率也有所增加。由于AUF在临床实践中很少见，泌尿科医生可能直到患者病情后期才意识到其存在；这种诊断延迟与高死亡率相关，因此需要快速的临床怀疑和调查行动。文献中提到了这种罕见疾病的散发病例。在本报告中，我们介绍了两例病例并对文献进行了综述。一名73岁女性因反复间歇性血尿一周就诊，尽管进行了多次影像学检查和手术，但症状原因一直难以确定。随后对泌尿系统进行数字减影血管造影，最终确诊为继发性右髂内-输尿管瘘。采用血管内介入方法对瘘管进行了栓塞。栓塞后患者病情稳定，术后不久成功出院。在第二例病例中，一名51岁女性因回肠代膀胱出现血尿数天。最初，认为症状原因是输尿管支架。在更换支架时，大量出血促使进一步检查，包括髂血管造影，证实出血来自左髂总动脉。她接受了带覆膜的髂总动脉支架植入，成功控制了出血。本报告强调了AUF的诊断困难，概述了这种罕见疾病的治疗原则，旨在提高泌尿外科和介入放射科医生对这种罕见但可能致命现象的认识。
