Uretero-arterial fistula – case report
Németh Máté dr., Szepesváry Zsolt Jenő dr., Mosonyi Péter dr.
Petz Aladár Egyetemi Oktató Kórház, Urológiai Osztály, Győr (osztályvezető: Szepesváry Zsolt Jenő dr.)
Introduction: Uretero-arterial fistula is a rare cause of hematuria, but its incidence is increasing. This phenomenon is mainly due to the extended life expectancy of pelvic tumour patients. The first symptom is typically major haemorrhage which then leads to acute anaemia.
Case description: A 46-year-old woman was treated with Wertheim hysterectomy and post-operative irradiation for uterus cervix carcinoma. She then underwent the Bricker bladder construction (cutaneous uretero-ileostomy) for post-irradiation bladder syndrome. Following a one-year asymptomatic and complaint-free period, she had to be repeatedly hospitalised as a result of gross hematuria. During one of these episodes an urgent CT scan revealed proof of a filling defect between the ureter and the common iliac artery on the left side, during the arterial phase. This was identified as a fistula and the source of bleeding.
Endovascular reconstruction procedure was considered based on vascular surgery consultation. A stent graft was implanted from the left femoral artery into the left iliac artery due to the ilio-ureteral fistula of the left bleeding artery.
Conclusion: The possibility of uretero-arterial fistula should emerge in case of intermittent, therapy-resistant hematuria which can’t be explained otherwise. If hematuria occurs in the context of the triad: irradiation, pelvic surgery, and ureteral stenting, then pelvic angiography is advised. Endovascular solutions are increasingly the preferred alternative over traditional open surgical procedures, due to patients’ complex anatomical issues.