Question:

Which of the following is NOT a known risk factor for the development of a ureteroarterial fistula?
1. Previous pelvic surgery
2. Prolonged use of ureteral stents
3. Young age
4. Presence of a ureteral stump after nephrectomy
5. Previous pelvic radiation





Answer:

The correct answer for the question "Which of the following is NOT a known risk factor for the development of a ureteroarterial fistula?" is:

3. Young age



Explanation
1. Prior pelvis surgery may be associated with inflammatory changes predisposing weakening of the connective tissue plans and allowing fistula formation.  [Previous pelvic surgery and radiation, may incite an inflammatory reaction weakening the connective tissue planes between structures such as artery and ureter].

2. Ureteral stents have also been described as a potential risk factor for developing ureteroarterial fistulas. [The prolonged use of ureteral stents placed at the ureteroarterial crossing predisposes abnormal fistulization of the structures].

3. Younger age is not a risk factor for developing ureteroarterial fistulas. The incidence of ureteroarterial fistulas is thought to increase with age. [The majority of cases have been described in women (86%) with an incidence higher in patients >50 year old]

4. The presence of a ureteral stump may predispose formation of a fistula [Conditions predisposing to the development of ureteroarterial fistulas include: the prolonged use of ureteral stents placed at the ureteroarterial crossing; radiation therapy in combination with surgery; the presence of a ureteral stump after nephrectomy; vascular reconstructive surgery, especially with anastomosis or pseudoaneurysms in the pelvis; surgery for uterine cancer or transitional cell cancer of the bladder; and ureterolithotomy complicated by urinary leak]

5. Prior radiation is a risk factor for ureteroarterial fistula formation [Previous pelvic surgery and radiation, may incite an inflammatory reaction weakening the connective tissue planes between structures such as artery and ureter].



From the manuscript:
Endovascular Management of Ureteroarterial Fistula: A Rare Potentially Life Threatening Cause of Hematuria
Radiology Case. 2014 Jul; 8(7):37-45


This article belongs to the Interventional section.




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From the manuscript

Endovascular Management of Ureteroarterial Fistula: A Rare Potentially Life Threatening Cause of Hematuria

Free full text article: Endovascular Management of Ureteroarterial Fistula: A Rare Potentially Life Threatening Cause of Hematuria

Abstract
Ureteroarterial fistula is a rare, potentially life-threatening cause of hematuria characterized by an abnormal channel between a ureter and artery. The rarity of this condition, complexity of predisposing risk factors and intermittence of symptoms may delay or obscure its diagnosis. With a high index of suspicion and careful angiographic evaluation, embarking on this condition is not only possible but sets the stage for curative intervention. We report a case of a ureteroarterial fistula presenting with intermittent hematuria, successfully diagnosed at angiography and managed with endovascular stent graft placement.






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