Case report. Significant gross hematuria from urinary diversion: a potentially life-threatening condition!

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

Arterio-ureteral fistula:a nationwide cross-sectional questionnaire analysis

PURPOSE: Arterio-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. METHODS: A 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. RESULTS: Response 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. CONCLUSION: The diagnosis AUF should be considered in patients with persistent intermittent or massive hematuria. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s00345-021-03910-3

Holmium laser lithotripsy for ureteral calculi: Predictive factors for complications and success

Purpose: To define possible predictive factors for success and complications for ureteroscopic holmium laser lithotripsy procedures. Patients and Methods: All 105 ureteroscopic holmium laser lithotripsy procedures performed between 1996 and 2005 were analyzed. Data recorded were sex, age, stone size, stone location, complications, success rate (stone-free rate after 3 months), operative time, and surgeon experience for this procedure. For further analysis, surgeon experience was divided into four groups based on the number of procedures performed. Multivariate analysis was used to define possible predictive factors for complications and successful procedures. Results: Total success rate was 84.8%. Complications were present in 13 patients (12.4%). Success rate was significantly (P = 0.03) related to surgeon experience, with 92.9% success in the most experienced group and 50% in the least experienced group. Furthermore, significantly more complications occurred with decreased experience (P = 0.03) complication rate was 4.2% in the highest experience group and 41.7% in the least experienced group. In our series, sex, stone location, size, and age did not significantly influence complication and success rates. Conclusion: Surgeon experience is a predictive factor for complications and success for ureteroscopic holmium laser lithotripsy for ureteric calculi. Experienced surgeons have fewer complications, and the success rate is higher. Sex, stone location, size, and age were not significantly related to complication or success rates