Zusammenfassung
Die iliakoureterale Fistel ist eine seltene Entität, die sich mit einer massiven, mitunter lebensbedrohenden Blutung manifestieren kann. Über die Hälfte der bisher bekannten Fälle wurden in den letzten 10 Jahren beobachtet. Ihre Ursachen finden sich häufig nach urologisch-gynäkologischen Malignomoperationen mit und ohne Radiatio, nach Einlage von ureteralen Stents und bei gefäßchirurgischen Erkrankungen bzw. nach rekonstruktiven Gefäßoperationen. Die Diagnostik - die Angiographie ist die Methode der Wahl - ist aufgrund der intermittierenden Symptomatik schwierig, Therapie und Prognose für das Leben und den Funktionserhalt der Niere hängen hiervon ab. Die offene chirurgische Versorgung ist weitgehend verlassen worden. Mit Einführung der interventionellen Methoden auf dem Hintergrund eines bildgebenden Fistelnachweises wurden die Morbidität und Letalität deutlich gesenkt. In unserer Abteilung wurden in den letzten 5 Jahren insgesamt drei Patienten mit einer iliakoureteralen Fistel behandelt. Bei zwei von ihnen kamen gecoverte Stents, einmal die alleinige Intervention, das Coiling der A. iliaca interna, erfolgreich zur Anwendung. Eine Versorgung des Ureters ist nicht zwingend erforderlich.
Abstract
Arterio-ureteral fistulas are rare. A lifethreatening complication is severe hemorrhage. More than 50 per cent of the cases were reported during the last ten years. The predisposing causes mainly are operations of malignomas of the kidney and the efferent urinary tract as well as gynecological neoplasias with or without irradiation. Stenting of the ureter or reconstructive vascular surgery may also cause arterio-ureteral fistulas. Because of the intermittent symptomatology diagnosis may be very difficult. Therapy and prognosis for life as well as for organ failure depend on pretherapeutic examination. In former times surgical repair was the therapy of choice. With the indroduction of interventional techniques morbidity and mortality decreased significantly. During the last five years three patients with iliac-ureteral fistulas were treated in our department. In two cases the fistulas was excluded by covered stent grafts, in one case coiling alone of the internal iliac artery was successful. Reviewing the literature and our experience with arterio-ureteral fistula angiography is recommended for diagnostics. Covered iliac stentgrafts are the therapeutic option of choice. The leakage of the ureter needs not to be repaired mandatoryly.
Schlüsselwörter
Arterioureterale Fistel - Stent-Graft - Hämaturie - Übersicht
Key words
Arterio-ureteral fistula - hematuria - stent graft - review
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Dr. J. Krenzien
Abteilung für Gefäß- und Thoraxchirurgie · Klinikum Ernst von Bergmann
Charlottenstraße 72
14462 Potsdam
Email: j.krenzien@t-online.de
