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. 2022 Mar;40(3):831-839.
doi: 10.1007/s00345-021-03910-3. Epub 2022 Jan 22.

Arterio-ureteral fistula: a nationwide cross-sectional questionnaire analysis

Tycho M T W Lock #  1 , Kyara Kamphorst #  2 , Roderick C N van den Bergh  3 , Frans L Moll  4 , Jean-Paul P M de Vries  5 , Rob T H Lo  6 , Gérard A P de Kort  6 , Rutger C G Bruijnen  6 , Pieter Dik  7   8 , Simon Horenblas  9 , Laetitia M O de Kort  2
Affiliations

Arterio-ureteral fistula: a nationwide cross-sectional questionnaire analysis

Tycho M T W Lock et al. World J Urol. 2022 Mar.

Abstract

Purpose: Arterio-ureteral fistula (AUF) is an uncommon diagnosis, but potentially lethal. Although the number of reports has increased over the past two decades, the true incidence and contemporary urologists' experience and approach in clinical practice remains unknown. This research is conducted to provide insight in the incidence of AUF in The Netherlands, and the applied diagnostic tests and therapeutic approaches in modern practice.

Methods: A nationwide cross-sectional questionnaire analysis was performed by sending a survey to all registered Dutch urologists. Data collection included information on experience with patients with AUF; and their medical history, diagnostics, treatment, and follow-up, and were captured in a standardized template by two independent reviewers. Descriptive statistics were used.

Results: Response rate was 62% and 56 AUFs in 53 patients were reported between 2003 and 2018. The estimated incidence of AUF in The Netherlands in this time period is 3.5 AUFs per year. Hematuria was observed in all patients; 9% intermittent microhematuria, and 91% presenting with, or building up to massive hematuria. For the final diagnosis, angiography was the most efficient modality, confirming diagnosis in 58%. Treatment comprised predominantly endovascular intervention.

Conclusion: The diagnosis AUF should be considered in patients with persistent intermittent or massive hematuria.

Keywords: Arterio-ureteral fistula; Endovascular procedures; Hematuria; Incidence; Stents.

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Conflict of interest statement

No conflict of interest.

Figures

Fig. 1
Fig. 1
Illustration to explain the pathophysiology of AUF. A Normal condition: a freely movable ureter with a pulsatile artery. The artery not affecting the ureter. B Pelvic surgery and/or radiation could cause fibrosis and ischemic injury. This leads to ureter obstruction and hydronephrosis and fixation of the ureter to the arterial wall. C Ureteral stent placement to treat hydronephrosis which causes friction due to less freely movable ureter. In time, fibrosis, ischemia and/or friction could cause localized necrosis and eventually AUF
See this image and copyright information in PMC

Comment in

References

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