Ureteroarterial Fistulas After Robotic and Open Radical Cystectomy

Abstract

Ureteroarterial fistulas (UAFs) are defined as an abnormal communication between one of the major arteries and the ureter. Urologists most frequently encounter iatrogenic fistulas occurring in patients with a history of pelvic extirpative surgery, chronic ureteral catheterization, and history of pelvic radiation. We present two cases of UAFs in patients with no history of prior radiation, who underwent open radical cystectomy and robot-assisted radical cystectomy with intracorporeal ileal conduit. Both patients developed postoperative ureteroileal anastomotic leaks that were managed with indwelling ureteral catheters. Furthermore, both patients were having left-sided UAF after presenting with nonlife threatening gross hematuria, which became brisk and pulsatile during ureteral stent exchange. Endovascular stenting was performed in both patients with resolution of hemorrhage and full recovery. In one patient, nephrostomy tubes were placed and ureteral catheters were removed; the second patient was managed with continued ureteral catheterization without further episodes of hematuria.

A multidisciplinary case of ureteroiliac fistula after radical cystectomy

“…2,4,5 Continuous pulsatile forces and the presence of ureteral stents and routine exchanges, which had occurred in our patient, facilitates fistula formation at the ureteroiliac passage. 1,6,11 Because of the rare occurrence of UIF, the diagnosis is often difficult and delayed. The initial presentation is often nonspecific.…”

“…2,4,5 The occurrence of unexplained gross hematuria with variable clot passage and flank pain in a patient with a history of pelvic surgery, a chronic ureteral stent, and/or history of pelvic radiotherapy is highly suspicious for a UIF. 2,6 A number of case reports and systematic reviews have suggested a comprehensive clinical evaluation and detailed treatment algorithms in the proper diagnosis and treatment of UIF, with endovascular approaches leading toward more favorable outcomes. 2,[6][7][8][9][10][11][12][13] We present the occurrence of a UIF in an 89-year-old man with a history of bladder cancer managed with radical cystectomy and chemoradiotherapy complicated by ureteral strictures that had required routine ureteral stent exchanges.…”

“…2,6 A number of case reports and systematic reviews have suggested a comprehensive clinical evaluation and detailed treatment algorithms in the proper diagnosis and treatment of UIF, with endovascular approaches leading toward more favorable outcomes. 2,[6][7][8][9][10][11][12][13] We present the occurrence of a UIF in an 89-year-old man with a history of bladder cancer managed with radical cystectomy and chemoradiotherapy complicated by ureteral strictures that had required routine ureteral stent exchanges. We have also discussed the proper diagnosis and treatment of these lesions.…”

Ureteroiliac fistula as a JJ catheter placement complication

“…Cabe destacar los antecedentes oncológicos, cirugías y tratamiento radioterápico pélvico que se da en todos los casos registrados (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13).…”

“…Además, en muchas ocasiones las primeras pruebas diagnósticas no evidencian la lesión y fuga de contraste. En nuestra revisión el principal método diagnóstico fue la arteriografía (3-13); sin embargo, en múltiples casos se realizaron previamente citoscopias, pielografías y/o TAC abdominales que mostraron resultados normales (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13).…”