Case report. Forse macrohematurie uit urostoma: een potentieel levensbedreigende situatie!

Abstract

Arterio-ureteral fistula (AUF) is a rare disease with a relatively high mortality rate that usually occurs after extensive pelvic oncological surgery in combination with radiation and chronic indwelling ureteral stents. In the Netherlands, approximately four AUF’s are diagnosed yearly, the real frequency is probably higher. The pathophysiology of the development of an AUF will mainly be based on chronic inflammation, fibrosis, poor vascularization and finally pressure necrosis. Localization of an AUF is mainly at the crossing of the ureter with the common iliac artery. AUF presents frequently in an acute setting with massive hematuria. The most sensitive diagnostic test is an angiography and the preferred initial treatment is endovascular.