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- Title
Early diagnosis and management of arterio-ureteral fistulas: A literature review.
- Authors
Prontera, Pier Paolo; Sciorio, Carmine; De Cillis, Antonio; Martinelli, Evangelista; Schiralli, Francesco; Lattarulo, Marco; D'Elia, Angelo; Utano, Emanuele; Grossi, Francesco Saverio
- Abstract
Objectives: Arterio-ureteralfistula (AUF) is an infrequent but potentially life-threatening condition. The aim of this study was reviewing the literature to build a flow-chart useful for an early and effective diagnosis and treatment of this pathology. Materials and methods: A literature search in PubMed was conducted. In addition, retrieved articles were cross-referenced. Data parameters included oncologic, vascular and urological history, diagnostics, treatment, and follow up were collected using a standard template by 2 independent reviewers. Results: A total of 140 cases of AUF out of 172 available in the literature at the time of the review, were considered. All patients presented gross hematuria. Chronic indwelling ureteral catheter (CIUC); history of pelvic surgery (HPS) and history of pelvic radiotherapy (HRT) were present respectively in 81%, 62.1% and 58.6% of the sample. The most predominant location of AUF was at the common iliac artery ureteral crossing. Angiography with provocative measures had the highest diagnostic sensitivity (50%) and endovascular treatment with stentgraft placement across the fistula is the current state of the art treatment choice. Conclusions: Failure to diagnose can postpone a potentially lifesaving targeted therapy and lead to complications. The identification of the Trifecta hematuria, history of pelvic surgery (HPS) and history of pelvic radiotherapy (HPR) would allow the identification of patients at high risk of AUF, who may benefit from more sensitive early diagnostic investigations such as CT angiography and provocative angiography. The treatment of choice in case of AUF to date consist in endovascular prosthesis placement.
- Subjects
EARLY diagnosis; LITERATURE reviews; FISTULA; ILIAC artery; ENDOVASCULAR surgery; IMPLANTABLE catheters
- Publication
Archives of Italian Urology & Andrology / Archivio Italiano di Urologia Andrologia, 2023, Vol 95, Issue 1, p1
- ISSN
1124-3562
- Publication type
Article
- DOI
10.4081/aiua.2023.10928