Ji Jiaxiang, Lai Chin-Hui, Lai Shicong, Xu Tao, Hu Hao
Department of Urology, Peking University People's Hospital, Beijing, China.
The Institute of Applied Lithotripsy Technology, Peking University, Beijing, China.
Transl Androl Urol. 2024 Sep 30;13(9):2160-2165. doi: 10.21037/tau-24-191. Epub 2024 Sep 26.
Ureteroarterial fistula (UAF) is a rare yet potentially life-threatening condition, which is challenging for urologists. It is traditionally treated by open surgical repair and endovascular repair. Intraureteral repair (IUR) was also previously reported, however all at the expense of normal kidney function. Here we present a case of unexpected UAF during urologic procedure which was successfully treated by a self-expanding Allium ureteral stent.
A 62-year-old woman diagnosed with bilateral ureteral stricture was admitted into our hospital for Allium stents insertion. However, she encountered an intraoperative emergency of UAF after ureteral balloon dilatation with presentation of urinary tract hemorrhage and hemodynamic instability. After consulting vascular surgeons, a clinical diagnosis of UAF was made. Three Allium stents were inserted in series. Urinary tract hemorrhage subsided immediately and circulation stability was quickly restored. Moreover, hydronephrosis was significantly relieved. No further hemorrhage occurred in the following 3 years.
Allium ureteral stent could be a feasible option for patients with UAF and should be considered by urologists. Our experience suggests that IUR with Allium stent could plug UAF effectively in an emergent setting. In addition, it preserves normal kidney function satisfactorily. Base on such merits, Allium stent provides a real possibility for IUR of UAF, which could potentially change the current treatment guideline.
输尿管动脉瘘（UAF）是一种罕见但可能危及生命的疾病，对泌尿外科医生来说具有挑战性。传统上通过开放手术修复和血管内修复进行治疗。先前也有输尿管内修复（IUR）的报道，但均以牺牲正常肾功能为代价。在此，我们报告一例泌尿外科手术中意外发生的UAF，通过自膨式葱状输尿管支架成功治疗。
一名62岁诊断为双侧输尿管狭窄的女性因植入葱状支架入院。然而，在输尿管球囊扩张后，她遭遇了术中UAF紧急情况，出现尿路出血和血流动力学不稳定。咨询血管外科医生后，做出了UAF的临床诊断。串联插入了三个葱状支架。尿路出血立即停止，循环稳定性迅速恢复。此外，肾积水明显缓解。在接下来的3年中未再发生出血。
葱状输尿管支架对于UAF患者可能是一种可行的选择，泌尿外科医生应予以考虑。我们的经验表明，使用葱状支架进行IUR可在紧急情况下有效封堵UAF。此外，它能令人满意地保留正常肾功能。基于这些优点，葱状支架为UAF的IUR提供了切实可能性，这可能会改变当前的治疗指南。
