Intermittent Arterial Hemorrhage From Ureteral-Arterial Fistula After Long-Term Ureteral Stenting

Ureteroarterial fistula (UAF) is a rare but potentially life-threatening condition that can cause massive hematuria. We report a case of UAF in a 74-year-old woman with a history of pelvic surgery, radiotherapy, and long-term ureteral stenting who presented with severe intermittent hematuria. The diagnosis was challenging because initial contrast-enhanced computed tomography showed no findings suggestive of UAF, and the bleeding pattern led to an initial suspicion of radiation cystitis. As hemorrhage recurred and anemia progressed, angiography was eventually performed and revealed a pseudoaneurysm of the left external iliac artery, leading to the diagnosis of UAF. Endovascular stent-graft placement achieved successful hemostasis. This case highlights that UAF should be suspected early in high-risk patients with intermittent hematuria, even when initial imaging findings are negative.