Ureteroiliac Fistula: Bleeding of Unknown Origin-Case Report and Review of the Literature

Ureteroiliac fistula is a rare cause of gross hematuria and lateralizing flank pain. Risk factors include previous pelvic surgery, pelvic radiotherapy, or chronic ureteral stentings. Diagnosis is challenging and requires arteriography and ureteroscopy. Management ranges from open surgery to minimally invasive means such as the use of an endovascular stent. A 62-year-old man with postradical cystoprostatectomy and cutaneous ureterostomy presented an intermittent gross hematuria with anemia that required blood transfusions. Some CT arteriographies were performed but none of them could identify the bleeding origin. Therefore, a flexible ureteroscopy was performed that showed a left ureteroiliac fistula. Subsequently, an endovascular stent was placed in the left common iliac without complications. The ureteroiliac fistula is a life-threatening condition. CT arteriography or ureteroscopy might help in the diagnosis but the sensitivity is ∼64%. Arteriography with endovascular stenting is a viable and safe option. However, because of its rarity, long-term durable benefits still need to be documented.