'Ooosh' haematuria syndrome from eroded and kinked vascular graft in the bladder

Arteriourinary fistulas may be primary or secondary. Primary fistulas (<15% of cases) are usually associated with aneurysmal degeneration of arteries or arteriovenous malformation, whereas secondary fistulas are associated with oncological surgery of the pelvis, radiation therapy and previous vascular surgery. Arteriourinary fistulas may occur between 2 and 25 years after the initial surgical procedure and seem to be more common in women. Mortality rates of 0-23% have been reported. Erosion or fistulation into adjacent gastrointestinal structures such as stomach or intestine is more common than into the genitourinary tract.4 Fistulas as a result of degenerated artery and ureter or synthetic graft and ureter have been well described. Erosion of prosthetic material into the bladder is well known, for example, synthetic slings for continence surgery and meshes used for hernia repairs. The erosion of vascular prosthesis into the bladder, however, is very rare and the expected average time to secondary fistulation is unknown. Arteriovesical fistulae may present with different degrees of haematuria ranging from microscopic to exsanguinating haemorrhage. Useful diagnostic modalities range from ultrasound, computed tomography, magnetic resonance angiography to cystoscopy.