Massive hemorrhage and cardiac arrest due to ureteroarterial fistula following nephroureteral stent removal: A case report

Ureteroarterial fistula (UAF) is a rare but potentially life-threatening cause of hematuria that often presents with diagnostic uncertainty. We report a 62-year-old woman with prior cystectomy with ileal conduit urinary diversion, pelvic radiation, and chronic nephroureteral stents (NUS) who presented with intermittent hematuria. In the interventional radiology suite, following NUS removal she developed massive hemorrhage and cardiac arrest. A massive transfusion protocol was initiated, and angiography immediately after NUS removal demonstrated active arterial extravasation. The NUS was reinserted for tamponade, and she underwent successful endovascular repair. This case highlights the diagnostic challenges of UAF and the importance of multidisciplinary management.