Arterio-ureteral fistula - A systematic review

Objective: to review published reports on arterio-ureteral fistula. Method: literature search. Results: eighty cases were identified. Primary fistulas were mainly seen in combination with aortoiliac aneurysmal disease. Secondary fistulas were se en after pelvic cancer surgery, often with radiation, fibrosis and ureteral stenting or after vascular surgery with synthetic grafting. The dominating symptom is massive haematuria, often with circulatory impairment. The chic to a rapid and correct diagnosis is a high degree of suspicion. Most frequ ently diagnosis has been obtained through angiography or pyelography. When there is a ureteral stent manipulation it will often provoke bleeding and l ead to diagnosis. The fistula must be excluded and a vascular reconstructio n made. Most frequently this has been obtained through occlusion Of the fis tula and an extra-anatomic reconstruction (femoro-femoral crossover). Recen tly stent-grafting has been successfully used but follow-up is short. Conclusion: arterio-ureteral fistula is rare and should be suspected in pat ients with complicated pelvic surgery and massive haematuria, especially wh ere rigid ureteral stents have been placed.