輸尿管髂動脈瘻管以經血管內套膜支架治療及診斷-個案報告及文獻回顧

楊浩誌、劉昱良、黃國財、林健煇、何東儒、林威宇、陳志碩、黃雲慶

財團法人嘉義長庚紀念醫院 外科部 泌尿科

Uretero-Iliac Artery Fistula Treatment with Endovascular Stent Graft: A Case Report and Review of Literature

Hao-Chih Yang, Yu-Liang Liu, Kuo-Tsai Huang, Jian-Hui Lin, Dong-Ru Ho, Wei-Yu Lin, Chih-Shou Chen, Yun-Ching Huang

Division of Urology, Department of Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan

Introduction:

  Uretero-arterial fistula (UAF) is a rare but lethal condition, the definite diagnosis is difficult and challenging.

Case presentation:

  We present a 63-year-old male with history of bladder cancer status post concurrent chemoradiotherapy and radical cystoprostatectomy with left to right transureteroureterostomy and right ureterocutneoustomy reconstruction about 2 years ago. Bilateral ureter stents were regularly changed. Unfortunately, sudden onset of gross hematuria was found from ureterocutaneoustomy. Computed tomography with contrast, angiography, ureterorenoscopy and RBC scan were done but all were negative findings. After retrograde pyelography, the diagnosis as uretero-Iliac artery fistula was confirmed. Endovascular stenting surgery was performed and no more hematuria was noted during the follow up.

Conclusion:

  The confirmation diagnosis of uretero-iliac fistula is still difficult and challenging, because no single test had enough sensitivity and specificity. In our case, retrograde pyelography is an important tool for diagnosis of UAFs. Further standard operation procedure for UAFs was warranted.