Ureteral tamponade to prevent catastrophic bleeding from uretero-vascular fistula in a patient with long-term indwelling ureteral stent

Abstract

A 56-year-old female experienced massive pulsatile bleeding from the left ureter during routine ureteral stent exchange. She had a history of radical cystectomy and bilateral stent insertion due to uretero-intestinal strictures. Upon stent removal, sudden bleeding through the urostomy led to hypovolemic shock. Urostomy site compression stabilized the patient, and CT revealed suspected ureteroarterial fistula. Angiography confirmed the diagnosis. Covered stent placement in the external iliac artery resolved the condition. No recurrence was observed during a three-year follow-up. Prompt tamponade followed by endovascular intervention can be life-saving in such cases.

Keywords: Endovascular stent; Hematuria; Ureteral stent complication; Ureteral tamponade; Ureteroarterial fistula.

Fig. 1

CT showing proximity of left ureter to external iliac artery (A) and the filled hematoma in both ureter and ileal conduit (B). Arrow: ureteral stent, dash line: iliac artery, asterix: hematoma in ureter and ilieal conduit.

Fig. 2

Angiography image did not show the extravasation in ureterovesical junction. Arrow: suspicious ureterovascular fistula lesion in left iliac artery.

Fig. 3

Placement of covered stent in left external iliac artery. Arrow: cover stent.