Arterioureteral Fistula

Abstract

Arterioureteral fistula is a rare clinical entity that has been reported more frequently over the past decade. The risk factors for arterioureteral fistula include previous pelvic or urologic surgery, ureteral stenting, pelvic irradiation, and previous vascular pathology. All patients who present with this clinical entity have at least one of these risk factors, and the majority of patients have more than one risk factor. Radiographic demonstration of an arterioureteral fistula may be difficult and often requires more than one diagnostic modality. Angiography and retrograde ureterography appear to be the most helpful in establishing a diagnosis. The literature suggests that patients with a diagnosis of arterioureteral fistula before surgery have an increased incidence of renal salvage and decreased mortality. Methods of repair have been varied, but in the past several years, endovascular approaches to this problem have become more common. The authors report two cases of arterioureteral fistulae, one managed operatively, and one managed by endovascular placement of a covered stent. The literature is reviewed, and etiology, diagnosis, surgical therapy, and endovascular therapy are discussed.