310 Rare Elusive Cause of Significant Haematuria – Case Series and Review of Literature

Abstract

Abstract Arterioureteral fistula (AUF) is a direct communication between the ureter and an artery and is a rare cause of catastrophic, life-threatening haematuria. Fistulation may occur between the ureter and the abdominal aorta, common iliac, external and internal iliac and inferior mesenteric arteries and is typically observed in patients with a prior history of pelvic radiotherapy, oncological pelvic surgeries, aortoiliac vascular procedures and pelvic exenteration. As AUF is so rarely encountered in clinical practice, the urologist may fail to appreciate its presence until late in the patient’s presentation. We are presenting case series as well as review of literature. Patient number 1 presented with repeated episodic large volume haematuria in whom the cause of symptoms remained persistently elusive despite repeated imaging. An eventual diagnosis of a secondary right internal iliac - ureteral fistula was ascertained on a subsequent Digital Subtraction Angiography of the renal tract. The fistula was embolised using an endovascular approach. The patient remained stable post emobilisation and was successfully discharged. Patient number 2 presented with haematuria from her ileal conduit. Initially the cause of symptoms was thought to be due to ureteric stents. During change in her stents, brisk bleeding led to further investigation including iliac angiogram confirming bleeding from left common iliac artery. She had covered common iliac artery stent which successfully controlled her bleeding. These cases emphasise the diagnostic difficulty of AUF, outlines the management principles of this rare disease and aims to increase awareness of this rare yet potentially lethal phenomenon amongst practitioners of urology and interventional radiology.