A fistula between an artery and a ureter can result in significant hematuria. Diagnosis may be delayed if the diagnosis is not considered, if the hemorrhage is intermittent, or if there are other causes for hematuria.


Risk factors:

(1) pelvic surgery

(2) chronic indwelling ureteral stent or catheter, with or without repeated ureteral dilatations

(3) pelvic irradiation

(4) vascular reconstructive surgery, especially using a synthetic graft material

(5) severe urinary tract infection

(6) presence of a ureteral stump after nephrectomy

(7) ureterolithotomy complicated by a urinary leak

(8) aortoiliac aneurysmal disease

(9) arteriovenous malformation adjacent to the ureter


Typical location: mid to distal ureter


Arteries involved:

(1) common iliac artery

(2) external iliac artery

(3) internal iliac artery

(4) aorta


Clinical features:

(1) hematuria, which may be intermittent or continuous

(1a) hematuria may range from microscopic to massive

(1b) The hemorrhage may be pulsatile.

(2) with massive hematuria the patient may develop hypotension and shock

(3) flank pain

(4) symptoms may mimic urinary tract infection or pyelonephritis


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