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Introduction: Arterioureteral fistula (AUF) is a rare but potentially life-threatening disease that primarily arises as a long-term complication in oncological patients who have permanent ureteral stenting. The incidence is rising. The objective of this study was to outline the risk factors for management and outcome of AUF in a large individual case series., Patients and Methods: Twenty-six AUF cases in 24 patients from six German tertiary referral centers occurring between 2008 and 2016 were identified retrospectively and entered into a dedicated database by using patient notes and out-patient visits., Results: Of 24 patients, 23 had a history of abdominopelvic surgery for oncological disease, 21/24 had undergone radiotherapy, and 23/24 had long-term ureteral stenting. All cases presented with visible hematuria, 11/26 at the time of a stent exchange. Blood transfusions were required in 92.3%, and intravenous inotropes were needed in 46.2%. Of 26 patients, 11 had flank pain. CT angiogram was positive in 35.7%. Angiography and endovascular fistula repair was performed in 88.5%, and the rest received open surgical repair. Mortality was 7.7%. Endovascular treatment was technically successful in 91.3%, and open surgery was successful in 3/4 cases. Recurrent AUF developed in 3/24 patients. Stent-related complications occurred in 15%. Vascular complications were common. Long-term survival was limited due to progression of the underlying malignant disease., Conclusion: AUF results in major hemorrhage and warrants time-efficient diagnosis and treatment. Awareness is key. When AUF is considered, interventional angiography should promptly be performed. Fistula detection can be improved by guidewire manipulation. Pre-interventional CT angiogram may be omitted due to low sensitivity. Endovascular repair with stenting and/or coiling is effective and safe.

Background: Cryoablation is an increasingly utilized treatment for renal-cell carcinoma. We describe the first reported case of colorenal fistula resulting from percutaneous renal cryoablation., Case Report: A 63-year-old man with hematuria was found to have an enhancing renal mass that was treated with percutaneous CT-guided cryoablation. Two months later, he presented with lower urinary-tract symptoms, and CT imaging revealed a colorenal fistula at the ablation site. Ureteral stent placement resulted in resolution of the fistula., Conclusions: Contrary to previously reported animal and clinical studies, our case report demonstrates that it is possible to incur serious harm to the renal collecting system as a result of percutaneous renal cryoablation. In stable patients, an attempt at conservative management of a fistula should precede extensive reconstructive efforts.

Background and Purpose: Urinary-tract fistulas present unique clinical challenges that often necessitate open surgical excision with interposition of healthy tissue. Advances in retrograde instrumentation have enabled endourologists to employ more minimally invasive approaches to urologic disease, including fistulas. We reviewed our experience with endoscopic injection of fibrin glue for the treatment of urinary-tract pathology., Patients and Methods: We performed a retrospective review of the eight patients at our institution who have undergone retrograde endoscopic injection of fibrin glue for the treatment of urinary-tract pathology. The data collected included age, presentation, treatment technique, method/duration of follow-up, complications, and success, which was defined as subjective and objective resolution of the treated pathology., Results: One of these patients was treated for a caliceal diverticulum refractory to percutaneous ablation. The other seven patients were treated for fistulas, including one colovesical fistula, two vesicovaginal fistulas, one ileal conduit-cutaneous fistula, one ureterocutaneous fistula, one urethrocutaneous fistula, and one ureterorectal fistula. All lesions except the urethrocutaneous fistula and the ureterorectal fistula were treated with a single injection of fibrin glue. At a mean follow-up of 11.75 months, this technique was successful in six cases (75%). Two (33%) of the successfully treated patients required two injections. There were no complications. Failures were apparent at initial follow-up., Conclusion: Retrograde endoscopic injection of fibrin glue offers a novel approach to ablation of caliceal diverticula. Additionally, although open surgical excision of urinary-tract fistulae remains the gold standard treatment, endoscopic injection of fibrin glue offers a safe, minimally invasive approach that may avoid the morbidity of open surgery in such challenging patients.

Fistula formation between a ureteral branch of a renal artery and the ipsilateral ureter is rare. We describe a case that followed ureterolithotomy of an impacted stone. Selective angiography with embolization of the bleeding branch was curative.

A 32-year-old woman presented to us with complaints of paradoxical incontinence for a period of 6 months following a cesarean section for obstructed labor performed elsewhere and subsequently treated elsewhere. Clinical and urographic assessment revealed an iatrogenic ureterouterine fistula, which was successfully treated endoscopically by dilatation of the ureteral stricture and ureteroscopic double-J stenting. It had been explained to the patient, and she had given consent for, ureteroneocystostomy in the event of failure. The literature regarding the management of this rare genitourinary fistula is reviewed and discussed.

We report the management of a nephroenteric fistula with percutaneous fulguration in a patient with recurrent pyelonephritis and urolithiasis. A nephrostogram at 6 weeks and retrograde pyelogram at 18 weeks after fulguration showed no evidence of a recurrent fistula. We believe this to be the first reported case of a nephroenteric fistula treated successfully with fulguration.

Because of the altered anatomy, the presence of immunosuppression, the possibility of graft rejection, and the serious implications of a problem involving a solitary kidney, the transplanted kidney presents unique challenges in the diagnosis and treatment of urologic complications. Historically, the mortality rate in these patients has been as high as 68%, and as many as 15% of the allografts have been lost. Today, endourologic procedures are used for prompt diagnosis, temporization, and even definitive management of many urologic complications, and many patients and allografts are being saved. The authors review present techniques and suggest others that may be available in the future.