Arterio-ureteral fistula: 11 new cases of a wolf in sheep's clothing
Autor: | Frans L. Moll, Tycho M.T.W. Lock, Roderick C.N. van den Bergh, Kakkhee K. Yeung, Jean-Paul P.M. de Vries |
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Přispěvatelé: | Surgery, ICaR - Ischemia and repair |
Rok vydání: | 2008 |
Předmět: |
Adult
Male Nephrology medicine.medical_specialty Urinary Fistula Urology medicine.medical_treatment Fistula urologic and male genital diseases Iliac Artery Cohort Studies Ureter Internal medicine Laparotomy medicine Humans Ureteral Diseases Aged Hematuria Retrospective Studies Aged 80 and over Vascular Fistula medicine.diagnostic_test urogenital system business.industry Stent Retrospective cohort study Middle Aged medicine.disease female genital diseases and pregnancy complications Surgery body regions Treatment Outcome medicine.anatomical_structure Angiography Female business Abdominal surgery |
Zdroj: | The Journal of Urology, 179(2), 578-581. Elsevier Inc. van den Bergh, R C N, Moll, F L, de Vries, J P P M, Yeung, K K & Lock, T M T W 2008, ' Arterio-ureteral fistula: 11 new cases of a wolf in sheep's clothing ', The Journal of Urology, vol. 179, no. 2, pp. 578-581 . https://doi.org/10.1016/j.juro.2007.09.087 |
ISSN: | 0022-5347 |
Popis: | We provide insight into the presentation, diagnostics, treatment, and accompanying clinical difficulties and complications of an arterio-ureteral fistula and add 11 patients with arterio-ureteral fistula to the 90 described in the literature.A retrospective search was done for confirmed cases of arterio-ureteral fistula that were treated at 3 medical centers.A total of 11 cases of arterio-ureteral fistula were reviewed from 1980 to 2006. A history of major abdominal surgery had an essential role in 10 of the 11 cases, especially vascular intervention in 8. All patients presented with varying manifestations of hematuria. Ureteral contrast studies and nonprovocative angiography provided the most valuable diagnostic information with all 5 and 3 of 5 showing positive results, respectively. In 4 of 11 patients (36%) the diagnosis of arterio-ureteral fistula was only made during laparotomy. Ten patients were treated with a classic open surgical approach (vascular and urological) and in 1 endovascular stents were inserted. Two of 11 patients (18%) needed acute surgical intervention because of hemodynamic instability. The in hospital mortality rate was 9%. At a mean followup of 17 months 3 other patients (27%) had died of causes unrelated to the arterio-ureteral fistula.The diagnosis of arterio-ureteral fistula should be considered in patients with persistent hematuria who have a history of major abdominal vascular surgery even when diagnostic test results are negative for a fistula, because in 36% of our patients the diagnosis could only be made at operation. The in hospital morbidity and mortality rates are considerable and, therefore, a timely diagnosis and elective multidisciplinary treatment are preferred. |
Databáze: | OpenAIRE |
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