[2 cases of uretero-arterial fistula].
Two cases of uretero-arterial fistulas are reported occurring in two patients after pelvic exenteration for cancer with cutaneous ureterostomy. In the first case a pelvic irradiation has been performed before surgery; in the other case a high degree of atherosclerosis was noted. Iliac artery-ureteral fistulas are uncommon and they are generally associated with several underlying pathogenic factors such as: arterial pathology, surgical complications, septis, prior x-ray therapy. It is not doubtfull that the use of a long term ureteral stenting contribute to the development of the fistula. The constant pulsation of the artery transmitted through the ureteral and the arterial wall to a stiff intraluminal stent produces a necrosis then a fistula between them. Retrograde uretero-pyelography seems the better diagnostic test. Treatment of these fistulas is always complex because operation should manage both vascular and ureteral injuries. Embolisation is a less invasive method of treatment but it needs a particular technics. Prognosis of such fistulas is poor and some precautions should be taken to prevent these accidents. When ureteral catheterization is needed for a long term one should assess the arterial conditions and during an operation catheterized ureter should be put far from the artery or an attempt for an epiplooplasty should be performed.
D000368:Aged; D004621:Embolization, Therapeutic; D005260:Female; D005402:Fistula / Q000209:etiology* / Q000601:surgery; D006801:Humans; D007083:Iliac Artery; D008297:Male; D008875:Middle Aged; D010385:Pelvic Exenteration / Q000009:adverse effects; D014515:Ureteral Diseases / Q000209:etiology* / Q000601:surgery; D014546:Urinary Catheterization / Q000009:adverse effects; D014547:Urinary Diversion / Q000009:adverse effects; D014548:Urinary Fistula / Q000209:etiology* / Q000601:surgery
Deux cas de fistules urétéro-artérielles.