Menasse F, Rossi D, Heckenroth H, Ayuso D, Albertini J N, Tournigand P
Service de Chirurgie Urologique, Hôpital Salvator, Marseille, France.
Prog Urol. 1997 Dec;7(6):1007-11.
Uretero-arterial fistulas are rare. The authors report two new cases complicating iliac vascular surgery. These fistulas occurred in a particular context: aorto-iliac disease, neoplasm and pelvic radiotherapy. Prolonged ureteric catheterisation is a risk factor found in 65% of cases. The clinical diagnosis is difficult and must be suggested in the presence of episodes of haematuria, sometimes minimal and intermittent, but often cataclysmic. The clinical context is highly suggestive of the diagnosis. The most useful complementary investigations are arteriography and retrograde ureteropyelography. Surgical treatment is complex, as it is performed in an emergency context in patients with a poor general state and it must treat both the vascular and the urological problem. Embolization can be proposed in some cases. The prognosis remains serious due to the frequency and severity of postoperative complications, which is why this disease must be investigated in all patients at risk.
输尿管动脉瘘较为罕见。作者报告了两例髂血管手术相关的新病例。这些瘘发生在特定背景下:主髂动脉疾病、肿瘤和盆腔放疗。65%的病例中发现长期输尿管插管是一个危险因素。临床诊断困难,在出现血尿时必须考虑到,有时血尿量极少且呈间歇性,但往往很严重。临床背景强烈提示诊断。最有用的辅助检查是动脉造影和逆行输尿管肾盂造影。手术治疗复杂,因为是在病情严重的患者紧急情况下进行,且必须同时处理血管和泌尿系统问题。在某些情况下可考虑栓塞治疗。由于术后并发症的发生率和严重程度,预后仍然严峻,这就是为什么必须对所有有风险的患者进行该病的检查。