Ureteroiliac artery fistula caused by full-length metallic ureteral stenting in a malignant ureteral obstruction: a case report

Background

The metallic stent is a new device for relieving the urinary tract in patients with malignant ureteral obstruction with short life expectancy and has been used frequently worldwide for its efficacy and safety. A ureteroarterial fistula with indwelling ureteral stent is rare but highly fatal, and there are several reports of ureteroarterial fistula treated by conventional polymer stents, although there are no reports on metallic stents. To our knowledge, this paper describes the first case of a ureteroiliac artery fistula caused by a full-length metallic ureteral stent in malignant ureteral obstruction.

Case presentation

Our patient was a 57-year-old Asian woman with a history of locally advanced cervical cancer who underwent abdominal total hysterectomy and chemoradiotherapy. She was diagnosed with right hydronephrosis and hydroureter secondary to upper ureteral obstruction because of retroperitoneal lymph node metastasis. A urinary tract obstruction after placement of 12 months of polymer stent followed by 18 months of metallic stent was relieved, consequently resulting in intermittent gross hematuria with bladder tamponade and anemia. Contrast-enhanced computed tomography could not reveal a ureteroarterial fistula; however, retrograde pyelography emphasized the existence of a ureteroiliac artery fistula. The patient underwent successful endovascular heparin-bonded stent graft placement, and her gross hematuria disappeared thereafter.

Conclusion

The metallic stent is a useful device for patients with malignant ureteral obstruction with a short life expectancy, although it may impose a higher pressure on the extraureteral tissue than conventional polymer stents due to its properties and may cause a ureteroarterial fistula. The narrowing of the external iliac artery diameter visualized by computed tomography may be helpful for predicting ureteroarterial fistulas.

Metallic ureteral stent in restoring kidney function: Nine case reports

BACKGROUND

Retroperitoneal fibrosis is an exceptionally rare disease characterized by proliferation of fibrous tissue and inflammation in the retroperitoneum. It features many symptoms in the kidneys and in other organs and usually leads to ureteral obstruction.

CASE SUMMARY

Here we present 9 consecutive cases of idiopathic retroperitoneal fibrosis (IRPF) in patients who presented to the Department of Nephrology or Department of Rheumatology, Xuanwu Hospital, Capital Medical University, Beijing, China, between January 2012 and June 2017 with ureteral obstruction due to external compression of the ureter that led to hydronephrosis and kidney dysfunction. Computed tomography imaging was used to identify hydronephrosis and ureteral obstruction and to evaluate kidney function. Each patient was diagnosed with IRPF based on clinical observation and computed tomography examination results. To restore kidney function, a retrograde metallic stent was placed in the ureter under X-ray guidance 2 d after each patient’s admission. No perioperative complications occurred in any patient, but postoperative complications occurred in two patients as follows: Patient 2 had stent migration and repeated metallic stent infections that resolved with treatment; and patient 4 had postoperative hematuria because he resumed normal activities too soon after stent placement (contrary to instruction). Placement of the metallic ureteral stents provided relief from ureteral obstruction and restored kidney function in all patients.

CONCLUSION

Our 9-case series underscores the utility and efficacy of applying the Resonance^® metallic ureteral stent to treat ureteral obstruction in patients with IRPF. For all retroperitoneal fibrosis cases in our series, ureteral stents provided effective relief and were shown to reduce the incidence rate of perioperative and postoperative complications.