Uretero-Arterial Fistula: A pitfall in the Diagnosis of Hematuria

The diagnosis and management of ureteroarterial fistulae (UAF) can be challenging. We report a patient who presented with multiple episodes of macroscopic hematuria but showed negative findings on several multiphasic computed tomography angiography studies. Eventually, during a percutaneous nephrostomy procedure, an antegrade digitally subtracted pyelogram via the right nephrostomy catheter demonstrated a UAF between the right external iliac artery and the right distal ureter. A stent-graft was deployed along the right common and external iliac arteries with embolization of the right internal iliac artery. A temporary ureteric occlusion technique was also used for urinary diversion, to promote UAF healing and to prevent stent-graft infection. The patient was treated with antibiotics for 4 weeks and is being managed with regular retrograde ureteral stent change every 3 months. This case report emphasizes the importance of early recognition and treatment of UAF.