A multidisciplinary case of ureteroiliac fistula after radical cystectomy

Abstract

Ureteroiliac fistula is a rare complication associated with ureteral stenting and iliac artery reconstruction and can lead to life-threatening hemorrhage. We report a case of acute bleeding from a ureteroiliac fistula in an 89-year-old man with bladder cancer who had undergone pelvic radiation, radical cystectomy, and ileal conduit complicated by ureteral strictures requiring routine stent exchanges. Multidisciplinary diagnostic therapies revealed the fistula, which was treated with hypogastric artery coiling and covered stent placement. No further bleeding issues had resulted from the fistula at 11 months of follow-up. The presence of a ureteroiliac fistula should be considered in any patient with a similar history.

Keywords: Endovascular; Hematuria; Ureteral stenting; Ureteroiliac fistula; Ureteroiliac passage.

Fig 1

Retrograde pyelogram completed by urology showing ureteroiliac fistula (UIF) at the level of the common iliac bifurcation with runoff into the left external iliac artery (EIA) and left hypogastric artery (HA).

Fig 2

Initial transfemoral angiogram performed by vascular surgery showing a widely patent vessel and absent communication into the left ureter.

Fig 3

Angiogram showing placement of three interlock coils in the left hypogastric artery (HA) and exclusion of the ureteroiliac fistula (UIF) with an 8-mm × 5-cm VBX covered stent graft (W.L. Gore).

Fig 4

Completion angiogram demonstrating complete exclusion of the ureteroiliac fistula (UIF) with normal flow from the left common iliac artery (CIA) into the left external iliac artery (EIA). Additionally seen is the VBX covered stent graft (W.L. Gore) deployed across the CIA and EIA and postdilated ≤10 mm in the CIA and ≤8 mm in the EIA.

Fig 5

Subsequent image at 3 months from one of his later stent exchanges showing the relationship of the stent graft, coils, and J-stent.