Description of clinical case:

Three patients with urostomy and permanent double J-stent who had frank, acute and anemia hematuria are presented. All three had received radiotherapy for pelvic oncological pathology with subsequent performance of cystectomy and urostomy for severe radiation cystopathy. In no patient was the CT scan performed for the study of hematuria, requiring urgent arteriography and showing the presence of a ureter-iliac fistula (UIF) at the level of the left common iliac artery, right common iliac artery and right external iliac artery, respectively. After the placement of a covered iliac endovascular prosthesis, instant resolution of the clinical picture was achieved.

Relevance:

FUI is an exceptional diagnosis requiring the experience of the urologist and the vascular radiologist. This situation can be potentially lethal when presenting a picture of acute frank hematuria and anemia.

Clinical implications:

Suspecting an IUF, ureteral catheter manipulation should be performed in a catheterization room, where immediate arterial control with percutaneous vascular techniques is readily available. The performance of an arteriography should be immediate, avoiding the performance of a CT due to its low sensitivity.

Conclusion:

Endovascular treatment with a covered stent is a safe and effective treatment for FUI.

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