Arteriocaliceal Fistula: A Life-Threatening Condition After Retrograde Intrarenal Surgery

Abstract

Background: Retrograde intrarenal surgery (RIRS) has emerged as a viable and safe option for renal stones <2 cm. Because of its high efficiency and relative safety, experienced endourologists have applied it to even larger stones. We present a case of arteriocaliceal fistula, which is a rare postoperative complication of RIRS. Case Presentation: A 52-year-old man with a rich history of endourologic procedures and extracorporeal shockwave lithotripsy caused by inferior caliceal calculi was subjected to RIRS. This was complicated by transient intraoperative hemorrhage, followed by recurrent hematuria and clot retention several days postoperatively. Renal arteriography revealed the presence of an arteriocaliceal fistula. This was completely resolved with selective arterial embolization. Conclusion: This case highlights that early detection and timely intervention are crucial to avoid serious consequences of post-RIRS hemorrhage resulting from arteriocaliceal fistula.

Keywords: endourology; nephrolithiasis; retrograde intrarenal surgery; surgical complication; urology.

FIG. 1.

Left kidney lower pole stone.

FIG. 2.

Arteriography showing arteriocaliceal fistula followed by ultraselective embolization with spring.