Abstract
PurposeArterio-ureteral fistula (AUF) is an uncommon diagnosis, but potentially lethal. Although the number of reports has increased over the past two decades, the true incidence and contemporary urologists’ experience and approach in clinical practice remains unknown. This research is conducted to provide insight in the incidence of AUF in The Netherlands, and the applied diagnostic tests and therapeutic approaches in modern practice.MethodsA nationwide cross-sectional questionnaire analysis was performed by sending a survey to all registered Dutch urologists. Data collection included information on experience with patients with AUF; and their medical history, diagnostics, treatment, and follow-up, and were captured in a standardized template by two independent reviewers. Descriptive statistics were used.ResultsResponse rate was 62% and 56 AUFs in 53 patients were reported between 2003 and 2018. The estimated incidence of AUF in The Netherlands in this time period is 3.5 AUFs per year. Hematuria was observed in all patients; 9% intermittent microhematuria, and 91% presenting with, or building up to massive hematuria. For the final diagnosis, angiography was the most efficient modality, confirming diagnosis in 58%. Treatment comprised predominantly endovascular intervention.ConclusionThe diagnosis AUF should be considered in patients with persistent intermittent or massive hematuria.
Highlights
Arterio-ureteral fistula (AUF) is a rare but potentially lethal complication, where a direct connection between artery or vascular graft and ureter exists
First clinical presentation is often intermittent hematuria, without any additional symptoms, which frequently ceases without any treatment [1, 2]
AUF may present with massive hematuria, especially during endoscopic ureteral instrumentation and/or stent replacement
Summary
Arterio-ureteral fistula (AUF) is a rare but potentially lethal complication, where a direct connection between artery or vascular graft and ureter exists. First clinical presentation is often intermittent hematuria, without any additional symptoms, which frequently ceases without any treatment [1, 2]. AUF may present with massive hematuria, especially during endoscopic ureteral instrumentation and/or stent replacement. Lock and Kyara Kamphorst contributed to this paper
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