Urologie pro praxi 4/2022

Hematuria caused by the internal illiac artery aneurysm with secondary arterio-vesical fistula

As well as in other departments of medicine, also in urology, we treat much older patients with more frequent comorbidities. Many of our patients have a history of reconstructive procedures on the vascular system. We encountered a complication in a patient after angiosurgery, which included closing a large aneurysm of the internal iliac artery by coiling. In this case study, a fistula between the vascular bulge and the bladder developed after filling the aneurysm with coiling and the hematuria was presented. However, the source of hematuria was not the fistula from the already filled bulge, but the bleeding of the vessels of the bladder mucosa due to congestion from compression by a large sac of the aneurysm of the internal iliac artery. Diagnosis and therapy of the cause of hematuria due to an aneurysm is very difficult because of its rare occurrence therefore it should involve a multidisciplinary team consisting of a urologist, vascular surgeon and interventional radiologist.

Keywords: aneurysm, hematuria, arterio-vesical fistula.