Ureteroarterial fistula – a severe manifestation of urological toxicity with possibly fatal consequences
Authors:
Jiří Špaček 1; Petr Hoffmann 2; Miroslav Lojík 2; Igor Guňka 3; Miloš Broďák 1; Jiří Petera 4; Jiří Špaček 5
Authors‘ workplace:
Urologická klinika LF UK a FN Hradec Králové
1; Radiologická klinika LF UK a FN Hradec Králové
2; Chirurgická klinika LF UK a FN Hradec Králové
3; Klinika onkologie a radioterapie LF UK a FN Hradec Králové
4; Porodnická a gynekologická klinika LF UK a FN Hradec Králové
5
Published in:
Ceska Gynekol 2024; 89(4): 293-297
Category:
Original Article
doi:
https://doi.org/10.48095/cccg2024293
Overview
Aim: A retrospective audit from a urological center focused on urological fistulas that directly connect with the treatment of gynecological malignancy. Ureteroarterial fistulas, i.e., pathological communication between the ureter and the artery, are discussed in more detail. Materials and methods: Over a period of ten years, from 2011 to 2020, a group of 47 patients with a diagnosis of urinary fistula was retrospectively evaluated. These patients, with a history of treatment for gynecological malignancy, were sent to our clinic from local and non-regional departments in the Czech Republic. We found three cases of ureteroarterial fistula in the presented analysis that focused on urological toxicity of oncogynecological treatment. Results: Within the mentioned period of ten years, we recorded 64 cases of urinary fistulas, and 47 patients (73.4%) were directly related to oncogynecological treatment. In the group with gynecological tumors, we found three patients (6.4%) with a diagnosis of ureteroarterial fistula, two of whom died directly related to this complication (exsanguination). These patients were treated for cervical cancer. All of them underwent radiotherapy during the treatment. Conclusion: Ureteroarterial fistulas are the most severe complications that can occur in medicine. This work confirms that we have encountered these cases even recently. Management is highly demanding for patients affected in this way and requires multidisciplinary cooperation. Endovascular intervention methods can control bleeding in emergency situations with non-surgical approaches. However, they are usually the first step towards a definitive surgical solution.
Keywords:
hematuria – malignancy – fistula – ureter – artery
Sources
1. Minář L, Weinberger V, Kysela P. Komplikace radikálních onkogynekologických operací. Ceska Gynekol 2010; 75 (4): 346–352.
2. Kamphorst K, Lock TM, van den Bergh RC et al. Arterio-ureteral fistula: systematic review of 445 patients. J Urol 2022; 207 (1): 35–43. doi: 10.1097/JU.0000000000002241.
3. Geavlete P, Georgescu D, Mulțescu R et al. Ureteral stent complications – experience on 50,000 procedures. J Med Life 2021; 14 (6): 769–775. doi: 10.25122/jml-2021-0352.
4. de Bernis L. Obstetric fistula: guiding principles for clinical management and programme development, a new WHO guideline. Int J Gynaecol Obstet 2007; 99 (Suppl 1): S117–S121. doi: 10.1016/j.ijgo.2007.06.032.
5. Bergqvist D, Pärsson H, Sherif A. Arterio-ureteral fistula – a systematic review. Eur J Vasc Endovasc Surg 2001; 22 (3): 191–196. doi: 10.1053/ ejvs. 2001.1432.
6. Abu-Rustum NR, Yashar CM, Arend R et al. NCCN guidelines® insights: cervical cancer, version 1.2024. J Natl Compr Canc Netw 2023; 21 (12): 1224–1233. doi: 10.6004/jnccn.2023.0062.
7. DiCostanzo GA, Kalman PG, Trachtenberg J. Erosion of the ureter by ileofemoral arterial prosthesis. J Vasc Surg 1988; 8 (2): 190–192.
8. Heers H, Netsch C, Wilhelm K et al. Diagnosis, treatment, and outcome of arterioureteral fistula: the urologist’s perspective. J Endourol 2018; 32 (3): 245–251. doi: 10.1089/end.2017.0819.
9. Ingelfinger JR. Hematuria in adults. N Engl J Med 2021; 385 (2): 153–163. doi: 10.1056/NEJM ra1604481.
10. Augustin AM, Dalla Torre G, Kocot A et al. Endovascular therapy of arterioureteral fistulas. Vasa 2020; 50 (3): 193–201. doi: 10.1024/0301-15 26/a000922.
11. Hagspiel KD, Turba UC, Bozlar U et al. Diagnosis of aortoenteric fistulas with CT angiography. J Vasc Interv Radiol 2007; 18 (4): 497–504. doi: 10.1016/j.jvir.2007.02.009.
12. Das A, Lewandoski P, Laganosky D et al. Ureteroarterial fistula: a review of the literature. Vascular 2016; 24 (2): 203–207. doi: 10.1177/ 1708538115585261.
13. Jadhav KK, Kumar V, Punatar CB et al. Retroperitoneal fibrosis-clinical presentation and outcome analysis from urological perspective. Investig Clin Urol 2017; 58 (5): 371–377. doi: 10.4111/icu.2017.58.5.371.
14. Subiela JD, Balla A, Bollo J et al. Endovascular management of ureteroarterial fistula: single institution experience and systematic literature review. Vasc Endovascular Surg 2018; 52 (4): 275–286. doi: 10.1177/1538574418761721.
15. Daye D, Walker TG. Complications of endovascular aneurysm repair of the thoracic and abdominal aorta: evaluation and management. Cardiovasc Diagn Ther 2018; 8 (Suppl 1): S138–S156. doi: 10.21037/cdt.2017.09.17.
16. Titomihelakis G, Feghali A, Nguyen T et al. Endovascular management and the risk of late failure in the treatment of ureteroarterial fistulas. J Vasc Surg Cases Innov Tech 2019; 5 (4): 396–401. doi: 10.1016/j.jvscit.2019.06.010.
17. Vicaretti M. Pathophysiology of vascular graft infections. Mechanisms of vascular disease: a reference book for vascular specialists. Adelaide (AU): University of Adelaide Press 2011.
18. Zelhof B, McIntyre IG, Fowler SM et al. Nephrectomy for benign disease in the UK: results from the British Association of Urological Surgeons nephrectomy database. BJU Int 2016; 117 (1): 138–144. doi: 10.1111/bju.13141.
19. Šámal V, Richter I, Paldus V et al. Maligní obstrukce močovodu. Onkologie 2022; 16 (6): 322–325. doi: 10.36290/xon.2022.068.
20. Košina J, Balík M, Holub L et al. Extra-anatomické stenty jako alternativa nefrostomie. Ces Urol 2015; 19 (3): 188–193.
21. Aravantinos E, Anagnostou T, Karatzas AD et al. Percutaneous nephrostomy in patients with tumors of advanced stage: treatment dilemmas and impact on clinical course and quality of life. J Endourol 2007; 21 (11): 1297–1302. doi: 10.1089/end.2006.0104.
22. Matsunaga F, Dambaeva A, Ponsky LE et al. Systematic review of the management of ureteroarterial fistulas after ileal conduit urinary diversion. AJR Am J Roentgenol 2021; 216 (6): 1452–1461. doi: 10.2214/AJR.20.23132.
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Paediatric gynaecology Gynaecology and obstetrics Reproduction medicineArticle was published in
Czech Gynaecology
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