Arterioureteral fistulas are uncommon but potentially life-threatening causes of hemorrhage that usually manifest as hematuria. Approximately 90 cases of arterioureteral fistulas have been reported in the English-language literature; nearly two thirds of these were reported during the past decade [1]. Predisposing factors for arterioureteral fistulas include pelvic surgery, chronic indwelling ureteral stents, and pelvic irradiation [1-6]. Arterioureteral fistulas are being diagnosed more frequently because of increased numbers of vascular reconstructions performed, more advanced and extensive treatments of pelvic malignancy, and chronic use of ureteral stents. However, diagnosis of arterioureteral fistulas still may be elusive because of the intermittent nature of the symptoms and the difficulty in confirming the fistulous communications using radiology [1-6]. The morbidity and mortality rates for patients with arterioureteral fistulas remain high (23% mortality rate between 1980 and 1997) [4], especially when the condition goes undiagnosed despite improvements in treatment and critical care.
Radiologists play an increasingly important role in the treatment of patients with chronic use of indwelling urinary catheters and are frequently asked to consult on patients with hematuria of uncertain cause [7]. Therefore, a heightened level of awareness and watchfulness against arterioureteral fistulas is necessary for rapid diagnosis and treatment. We review the causes, risk factors, pathogenesis, signs and symptoms, diagnostic studies, and options for treatment of arterioureteral fistulas.