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
