Hi,
I must admit this is not something we come across too often. I would have done hundreds of retrograde pyelograms, but I have never diagnosed a pyelo-venous fistula yet. ( The appearance of blood in venous channels might on rare occasions be present when a contrast XXXXXXX is injected into the pelvis with too much pressure -We call it pyelovenous backflow and would be happier with that diagnosis rather than a fistula) Common things are, all said and done, common, and thus a relatively more common cause of haematuria like a stone or infection should ideally be looked for and treated, especially considering that you have never had a urological procedure like a nephrostomy which might be rarely a cause of a pyelo-venous fistula.
If you have no blood right now, then you should possibly relax, and avoid exertion over the next few weeks till your appointment with the vascular surgeon comes up. I doubt if there is going to be anything surgical that would be needed at this stage when you have no symptoms, especially as your CT with angiogram has come normal. On rare occasions, a conventional angiogram with DSA technique might pick up what was missed on earlier scans, but that call is for the vascular surgeons to make.
Hope I have been of help. Let me know what happens after the consultation with the vascular surgeon.

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Hi again,
Unless you cannot postpone your trip, I would rather you defer your trip to Europe till the status of bleeding is clarified. It is highly possible that you might not bleed ever from the fistula (if any), but the literature regarding this entity is so sparse that it would be better to err on the side of caution, especially if you are going to a new country where you are not too sure how the medical facilities would be in the case of an emergency. If the trip that you need to take is such that you cannot postpone it, make sure you go to a place where super-speciality medical services are available round the clock.
The other options would be to see a vascular surgeon earlier than planned, and get the other tests (like angiogram or MR Angiogram) done with so that you can proceed in peace.
Could Cipro have cleared any infection? - If a urine examination or a culture was done which suggested a bacterial infection sensitive to Ciprofloxacin - possible.
The tight ureters are unlikely to have any relation to bleeding which you have experienced. When we do a flexible ureteroscopy, we do encounter ureters which do not allow the passage of the scopes the way we would like, in which case we place stents and return later by which time the passage would have opened up by passive dilatation sufficiently for the scopes to reach the kidneys where we can do a more detailed, leisurely examination without causing trauma to the ureters or kidneys.
Glad to have been of help. Please let me know your progress.

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Hi,
I certainly can understand when you said you are a worrier by nature!
Yes, Ideally the CT angiogram ought to have picked up a fistula, but what we call it's sensitivity is about 95%, meaning it is not 100%, especially if it is a minor one.
Having said that, there is nothing which says that even a conventional angiogram (which is probably why you must have been referred to a vascular surgeon) will show up the fistula. I have had occasions when we did an angiogram for a patient with bleed from a fistula (post-operative after nephrostomy for a renal calculus) where we had to repeat the angiogram after the first one did not pick up the very small connection which was causing the bleed. You need to have a skilled interventional radiologist / vascular surgeon for this. An experienced radiologist also might be able to pick up a fistula with the help of an ultrasound and color doppler examination, but it needs very high skills, but should this option be available before your vascular surgeon's appointment, you can try it out, and if the radiologist feels convinced after perusing the previous and new scans that there is no major issue, you may possible set out on your trip with appropriate caution.

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Hi,
Yes, The fact that it is not bleeding now is probably a good sign.
The patient I was talking about had a very difficult renal calculus surgery in what we call diverticulum of the calyces, and in such patients the bleeding is not entirely unexpected.
Regarding the ultrasound, I do not mean it is better than CT. CT scan with contract with reconstruction of the angiogram is always going to be better than Ultrasound. Ultrasound will only help in screening for such lesions, and in the hands of a skilled operator, a fistula might become visible as an abnormal communication with flow in area where there should be no flow, especially if the previous urologist has given some indication that the spill they noticed was in the upper or middle or lower parts of kidney. The advantage with ultrasound is that you can repeat screening if required, while you cannot keep repeatedly doing a CT scan.
The ovarian cyst will most likely have no bearing on your current problem.
Regards and best wishes.

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Hi,
Obviously it is easy for me to say stop worrying, but I can understand your anxiety.
Your slightly prominent left ovarian vein has almost nothing to do with whatever bleed they might have noticed from your right ureter.
A CT angiogram can miss a small bleed, but I personally do not feel it would have grown big over the past 3 weeks., or will grow to a considerable size in the next few weeks. Unfortunately literature regarding this entity is sparse, and experience is limited, so for the moment, you probably should choose 'safety first'.
Regards.

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