Transurethral coil embolization for the management of ureteroarterial fistula : a case report

Abstract

72歳女性.患者は左尿管結石の治療と間欠的な高度の血尿を主訴に紹介となった.だが, 治療として施行した結石摘出後も血尿は持続し, 右尿管ステント交換時には出血性ショックになった.そのため, 選択的腸骨動脈造影より右尿管腸骨動脈瘻と診断し, 血管内ステント留置のみでは瘻孔は閉塞できなかったが, その後の経尿道的金属コイル塞栓術は奏功し, 血尿は軽快した.7ヵ月後の現在, 再発は認めていない.なお, 同疾患に対し経尿道的処置で軽快した報告はこれまで見当たらない

A 71-year-old woman who had undergone a total abdominal hysterectomy and pelvic irradiation for cervical cancer and fecal diversion for adhesive ileus was referred to us for a "left" ureteral stone and intermittent gross hematuria. Bilateral ureteral stents had been indwelled because of lower ureteral strictures for a long time. Hematuria continued after the removal of the ureteral stone, and she once went into hypovolemic shock at the time of exchange of the right ureteral catheter. Selective arteriography revealed a "right" ueteroarterial fistula. Endovascular management alone failed to resolve the fistula, but a subsequent transurethral metal coil embolization was effective, and the hematuria was relieved. She is still free from disease at 7-month followup. As far as we know, there has been no previous report of a transurethrally managed ureteroarterial fistula.