Vascular-Urinary Fistula

A vascular-urinary fistula is defined as a confirmed abnormal passageway between any vascular structure and any part of the urinary tract. Arterio-ureteral fistula is the most common type. Risk factors for developing this condition include previous pelvic radiation or surgery, vascular surgery or stenting, and indwelling ureteral stents. An increase in the incidence has been suggested. In patients with unexplained hematuria, this condition should be included in the differential diagnosis. Hematuria can either present as intermittent microscopic symptoms or as life-threatening gross hematuria. Awareness of the possibility of this condition, and knowledge of the underlying risk factors, could avoid delay of the diagnosis. Angiography or ureteral contrast studies confirmed the diagnosis most frequently, especially when active bleeding is present or excited by manipulation, although laparotomy has been often described when diagnosis remained uncertain. Endovascular treatment is the primary therapy of first choice.