Abstract
IntroductionAlthough diagnostic ureterorenoscopy is a minimally invasive and effective diagnostic procedure, it has the potential for significant postoperative complications. We report the first case in the literature of intrarenal arteriovenous fistulas causing hemodynamic effective anemia 4 days after ureterorenoscopic biopsy.Case presentationA 63-year-old Caucasian woman presented with hemodynamic effective macrohematuria (hemoglobin 70 g/liter) 4 days after ureterorenoscopy and biopsy of the upper pole collecting system due to recurrent microhematuria. Duplex-sonography and computed tomography angiography revealed multiple arteriovenous fistulas and erosions into the calyceal system. Intra-arterial digital subtraction angiography confirmed this condition. After superselective embolization of the arteriovenous fistulas, the patient had no further episodes of bleeding or microhematuria.ConclusionIf malignancies, urolithiasis or urinary tract infections are ruled out by common diagnostic procedures as the cause of recurrent minor or gross hematuria, the possibility of arteriovenous fistulas should be included in the differential diagnosis and Duplex-Sonography or the more invasive selective renal arteriography should be performed as this is the most definitive method for diagnosing arteriovenous fistula.
Highlights
Diagnostic ureterorenoscopy is a minimally invasive and effective diagnostic procedure, it has the potential for significant postoperative complications
If malignancies, urolithiasis or urinary tract infections are ruled out by common diagnostic procedures as the cause of recurrent minor or gross hematuria, the possibility of arteriovenous fistulas should be included in the differential diagnosis and Duplex-Sonography or the more invasive selective renal arteriography should be performed as this is the most definitive method for diagnosing arteriovenous fistula
We report a case of intrarenal arteriovenous fistulas causing hemodynamic effective anemia 4 days after ureterorenoscopic biopsy
Summary
Congenital AVFs are rare conditions which may cause cardiovascular complications (in 50% of cases) and recurrent hematuria in more than 75% of individuals. Urolithiasis or urinary tract infections are ruled out by common diagnostic procedures as the cause of recurrent minor or gross hematuria, the possibility of AVFs should be included in the differential diagnosis and Duplex-Sonography, or the more invasive selective renal arteriography, as the most definitive method for diagnosing AVF, should be performed. Depending on the general condition of the patient and their symptoms, the treatments of choice include nephrectomy and partial nephrectomy but most urologists aim for superselective embolization. AVF: arteriovenous fistula; CTA: computed tomography angiography; DSA: digital subtraction angiography; i.a. DSA: intra-arterial digital subtraction angiography; RR: blood pressure (measured by the technique of Riva Rocci); URS: ureterorenoscopy
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