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Introduction: Arterioureteral fistulas are rare, life-threatening, and difficult to diagnose. Risk factors are medical interventions in the lesser pelvis (general, urological, gynecological, and vascular surgery), radiation therapy of the lesser pelvis, permanent double J catheters, and previous vessel malformations., Materials and Methods: We retrospectively evaluated all cases of arterioureteral fistulas registered over the last 10 years in the clinic's documentation system. For all cases, clinical symptoms, diagnostics, therapies as well as clinical outcome were evaluated., Results: Four of the 5 patients were women. The most common initial symptom was a gross hematuria (4/5). All patients had a permanent double J catheter after extensive surgery of the lesser pelvis. In one case the initial diagnosis was done by retrograde ureterography, in 2 patients by provocative angiography and in the other 2 cases with a laparotomy due to cardiovascular problems. Three patients were treated by open surgery and 2 patients were treated by stenting of the iliac artery. One patient died, 2 patients had a permanent kidney fistula, and 2 patients continued treatment with a permanent double J catheter., Conclusion: Based on the more aggressive therapy regimens, we expect that the number of patients presenting with arterioureteral fistulas will continue to rise. The identification of these patients based on their risk profile is essential.

Background Ureteral arterial fistulas are rare but potentially life threatening. We present a female who developed a ureteral arterial fistula following a right robotic nephrectomy. After several endovascular interventions to control the bleeding had failed, we approached the fistula through the right ureteral stump with coil embolization. Methods Coil embolization of the right ureteral stump was performed. We utilized a 6Fr × 45 cm sheath inserted through one of the cystoscope channels to cannulate the right ureteral orifice. We then performed a retrograde ureterogram. After, we were able to visualize full length of the ureter, ahd we began placing several 10-12 mm Nester coils to pack the ureter and tamponade the fistula for hemostasis. After the ureter was packed, we injected 1 g of Vancomycin into the ureter. The sheath and cytoscope were removed and the patient did well and was sent to the recovery room. Results Postoperatively, the patient had no complaints of hematuria and her hemoglobin level remained unchanged. She was observed for a few days prior to being discharged to home. The patient's follow-up at six months revealed resolution of her hematuria. Conclusion Ureteral arterial fistula is a potentially life-threatening condition. Endovascular stenting has provided a safe, reliable alternative to open surgery. However, when endovascular options are not satisfactory, coil embolization of the ureteral stump may serve as a safe and effective alternative treatment for these cases.

Purpose: To evaluate the safety, efficacy and outcome of percutaneous balloon-expandable covered stent graft placement for uretero-iliac artery fistula (UAF) treatment., Methods: This retrospective study evaluated the single-center experience of percutaneous balloon-expandable covered stent graft placement (ADVANTA™, Atrium Hudson, NH, USA) in UAF. Data were obtained from a prospective institutional database. Patient follow-up included complications, symptoms recurrence and mortality rate., Results: Ten UAFs in eight patients (3 males; 5 females) with a mean age of 64.5 (35-77) years were identified. All patients had a history pelvic malignancy, extirpative surgery (n = 6), long-term ureteral stenting (n = 7) and pelvic radiation (n = 5). All procedures were completed successfully without complications. Thirty-day mortality rate was zero. At a median follow-up of 6 (1-60) months, one patient suffered recurrent hematuria requiring a secondary stent graft placement 26 months after the initial treatment. During follow-up, five patients died of the underlying disease (43, 66, 105, and 183 and 274 days after the last procedure)., Conclusion: Percutaneous balloon-expandable stent graft placement in UAF is a safe and effective treatment option. Implantation of stent grafts should be considered as treatment of choice in UAF.

Although ureteroarterial fistulas are rare, they result in a high mortality because of the massive urogenital haemorrhage. The diagnosis is often difficult even when invasive measures are applied. Including the ureteroarterial fistula in the diagnostic process in cases of macrohaematuria with a positive medical history can be helpful. A ureteroarterial fistula typically develops in pa-tients who have undergone pelvic surgery and radiation as well as after long-term ureteral stents. Patients are usually multimorbid. The treatment of choice consists of fistula exclusion by stent graft deployment in the iliac artery and application of a ureteral stent or a ureterostomy. The significance of surgical treatment is diminishing. The long-term results of endovascular treatment, however, are inconsistent because of stent infections and recurrent bleeding. Therefore, close patient surveillance and cooperation among the treating specialists is necessary.·, (© Georg Thieme Verlag KG Stuttgart · New York.)

Purpose: To evaluate the safety, efficacy, and long-term results of endovascular stent graft placement for ureteroarterial fistula (UAF)., Methods: We retrospectively analyzed stent graft placement for UAF performed at our institution from 2004 to 2012. Fistula location was assessed by contrast-enhanced computed tomography (CT) and angiography, and freedom from hematuria recurrence and mortality rates were estimated., Results: Stent graft placement for 11 UAFs was performed (4 men, mean age 72.8 ± 11.6 years). Some risk factors were present, including long-term ureteral stenting in 10 (91%), pelvic surgery in 8 (73%), and pelvic radiation in 5 (45%). Contrast-enhanced CT and/or angiography revealed fistula or encasement of the artery in 6 cases (55%). In the remaining 5 (45%), angiography revealed no abnormality, and the suspected fistula site was at the crossing area between urinary tract and artery. All procedures were successful. However, one patient died of urosepsis 37 days after the procedure. At a mean follow-up of 548 (range 35-1,386) days, 4 patients (36%) had recurrent hematuria, and two of them underwent additional treatment with secondary stent graft placement and surgical reconstruction. The hematuria recurrence-free rates at 1 and 2 years were 76.2 and 40.6%, respectively. The freedom from UAF-related and overall mortality rates at 2 years were 85.7 and 54.9%, respectively., Conclusion: Endovascular stent graft placement for UAF is a safe and effective method to manage acute events. However, the hematuria recurrence rate remains high. A further study of long-term results in larger number of patients is necessary.

The authors intended to perform a comprehensive review of the literature pertaining to ureteroarterial fistulae and apply the findings to a case. A comprehensive literature search was performed using the Keywords: ureter, artery and fistula. The available articles printed in or translated to English were analysed for overall trends. The results were then compared with the case of a patient (index patient). Review of the literature reveals that 57% of all ureteroarterial fistulae form in women at an average age of 58. The most common presenting complaint is haematuria. There appears to be a shift in management from primarily open surgical to primarily angiographic. The known risk factors are: vascular pathology, malignancy, prior radiation and indwelling stents. While 98% of all cases have at least one known risk factor, only 41% had two or more. We report an additional case of this rare condition, and review the present literature.

Purpose: To review the indications and results of open surgical and endovascular treatment for ureteral-iliac artery fistula (UIAF)., Methods: We reviewed the clinical data of 20 consecutive patients treated for 21 UIAFs between 1996 and 2010. Since 2004, iliac artery stent grafts were the primary treatment except for complex fistulas with enteric contamination or abscess. Endpoints were early morbidity and mortality, patient survival, vessel or graft patency, freedom from vascular or stent graft/graft infection, and freedom from recurrent bleeding., Results: There were 20 patients, 15 females, and five males, with mean age of 63 ±13 years. Predisposing factors for UIAF were prior tumor resection in 18 patients, radiation in 15, ureteral stents in 15, ileal conduits in four, and ileofemoral grafts in three. All patients presented with hematuria, which was massive in 10. Treatment included iliac stent grafts in 11 patients/12 fistulas (55%), with internal iliac artery (IAA) exclusion in nine, femoral crossover graft with IAA exclusion in five, direct arterial repair in three, and ureteral exclusion with percutaneous nephrostomy and no arterial repair in one. There were no early deaths. Five of eight patients treated by open surgical repair developed complications, which included enterocutaneous fistula in three and superficial wound infection in two. Four patients (36%) treated by iliac stent grafts had complications, including pneumonia, non-ST segment elevation myocardial infarction, buttock claudication, and early stent occlusion in one each. After a median follow-up of 26 months, no one had recurrent massive hematuria, but minor bleeding was reported in three. Patient survival at 5 years was 42% compared with 93% for the general population (P < .001). Freedom from any recurrent bleeding at 3 years was 76%. In the stent graft group, primary and secondary patency rates and freedom from stent graft infection at 3 years were 81%, 92%, and 100%., Conclusions: UIAF is a rare complication associated with prior tumor resection, radiation, and indwelling ureteral stents. In select patients without enteric communication or abscess, iliac artery stent grafts are safe and effective treatment, and carry a low risk of recurrent massive hematuria or stent graft infection on early follow-up. Direct surgical repair carries a high risk of enterocutaneous fistula., (Published by Mosby, Inc.)

Ureteral arterial fistula (UAF) is an uncommon condition but one that has been increasing with over 100 cases reported. The presentation is gross hematuria in a patient with predisposing factors, such as prior pelvic surgery, past radiation therapy, and chronic ureteral stenting. When not correctly diagnosed, the associated mortality is significant. Diagnosis is best accomplished by careful angiography with frequent use of provocative maneuvers. The current best therapeutic option is sealing off the UAF by deploying a stent graft in the artery.

Ureteroarterial fistula is a rare condition with life-threatening hematuria that should be diagnosed and treated immediately. We reported two patients of ureteroarterial fistula who underwent successful endovascular treatment by stent-grafts. They had undergone pelvic surgery followed by placement of an indwelling ureteral stent for stricture of the ureter before sudden hematuria occurred. Routine contrast-enhanced computed tomography did not reveal extravasation or a pseudo-aneurysm. Angiograms with multiple oblique views demonstrated small pseudoaneurysms of the iliac artery overriding the ipsilateral ureter. The endovascular treatment of ureteroarterial fistula using stent-grafts was successful, and the hematuria disappeared immediately after stent-graft deployment. The hematuria did not recur up to the last follow-up visits of 3 and 19 months, respectively.

Ureteroarterial fistulae (UAFs) are rare but potentially life-threatening entities that require a high degree of suspicion for diagnosis followed by prompt intervention. This case report describes the successful management of the oldest woman to-date presenting with intermittent hematuria, secondary to a fistula between the ureter and internal iliac artery, which was subsequently resolved by coil embolization. Morbidity and mortality associated with UAFs can be decreased by increasing awareness of this rare but fatal complication. Our review of the medical literature indicates that this is the oldest woman reported to have developed a UAF after radiation therapy and chronic ureteral stent exchange, as well as the first reported management of a UAF by interventional cardiologists.

Background: A 66-year-old man presented to hospital with gross hematuria and clots. He had previously undergone surgical repair of a right iliac artery aneurysm with placement of a vascular prosthesis at the same hospital, which had resulted in iliac urethral stricture that required the placement of a right ureteral stent. He had attended repeatedly for recurrent ureteral stent replacement, with the most recent replacement having occurred 1 month before the current presentation., Investigations: Ultrasonography, cystography, retrograde pyelography and provocative arteriography via a percutaneous right femoral arterial approach., Diagnosis: An iliac-artery-ureteral fistula between the right ureter and a pseudoaneurysm of the right common iliac artery., Management: The patient underwent placement of a covered, self-expandable vascular stent with angioplasty balloon, which resulted in complete exclusion of the pseudoaneurysm and fistula and resolution of the patient's hematuria. A pigtail catheter was placed in the right ureter for 5 days and replaced with a double-J ureteral stent on day 6 after exclusion of the pseudoaneurysm; the patient was discharged from hospital on the same day. Color-Doppler ultrasonography of the right iliac vessels performed 2 months later showed patency of the right iliac artery. The patient's ureteral stent has been replaced every 2 months since his discharge without recurrence of hematuria.

Purpose: We provide insight into the presentation, diagnostics, treatment, and accompanying clinical difficulties and complications of an arterio-ureteral fistula and add 11 patients with arterio-ureteral fistula to the 90 described in the literature., Materials and Methods: A retrospective search was done for confirmed cases of arterio-ureteral fistula that were treated at 3 medical centers., Results: A total of 11 cases of arterio-ureteral fistula were reviewed from 1980 to 2006. A history of major abdominal surgery had an essential role in 10 of the 11 cases, especially vascular intervention in 8. All patients presented with varying manifestations of hematuria. Ureteral contrast studies and nonprovocative angiography provided the most valuable diagnostic information with all 5 and 3 of 5 showing positive results, respectively. In 4 of 11 patients (36%) the diagnosis of arterio-ureteral fistula was only made during laparotomy. Ten patients were treated with a classic open surgical approach (vascular and urological) and in 1 endovascular stents were inserted. Two of 11 patients (18%) needed acute surgical intervention because of hemodynamic instability. The in hospital mortality rate was 9%. At a mean followup of 17 months 3 other patients (27%) had died of causes unrelated to the arterio-ureteral fistula., Conclusions: The diagnosis of arterio-ureteral fistula should be considered in patients with persistent hematuria who have a history of major abdominal vascular surgery even when diagnostic test results are negative for a fistula, because in 36% of our patients the diagnosis could only be made at operation. The in hospital morbidity and mortality rates are considerable and, therefore, a timely diagnosis and elective multidisciplinary treatment are preferred.

Uretero-iliac fistula is a rare cause of frank haematuria. The aetiology of such fistula is commonly iatrogenic. We present a unique case of a primary aorto-iliac fistula in the absence of an aneurysm or arteriovenous malformation. The diagnosis was demonstrated by ureteroscopy and real-time retrograde ureterogram. Multiple arterial embolisation of the fistula had failed, and the patient underwent a successful ureterolysis and ligation of fistula. We demonstrate the diagnostic difficulties and treatment dilemma of such rare cause of haematuria.

A 37-year-old man underwent Miles' operation and adjuvant irradiation therapy for rectum cancer in 1999. The patient suffered from bilateral ureteral stricture after the previous therapies. Bilateral double-J ureteral stents were inserted and exchanged at regular intervals. Four years after the start of ureteral stenting, he complicated with gross hematuria and dysuria. When the right double-J stent was exchanged, massive bleeding from external opening of urethra was observed. Retrograde pyelography showed right uretero-iliac arterial fistula. Since endovascular treatment with covered stents had failed, we performed right common iliac artery embolization and femoral-femoral artery bypass. Two days after the operation, gross hematuria developed again. When the left ureteral stent was exchanged, active bleeding from the external meatus of urethra was revealed. Angiography showed extravasation from left common iliac artery. We diagnosed left uretero-iliac arterial fistula. Although we tried endovascular treatment with covered stent that was made of artificial vessel graft and metallic stent, thromboembolism was occurred in the covered stent. Finally, right axillo-femoral artery bypass was indicated. The last treatment achieved long-term good control of uretero-arterial fistula. The present case shows that uretero-arterial fistula is a serious complication of long-term ureteral stenting, especially in the case of post pelvic surgery and irradiation.

We report an unusual case of a ureteroiliac fistula due to prolonged ureteral stenting for hydronephrosis combined with an aortic-bifemoral stent graft in an inflammatory abdominal aortic aneurysm (AAA), treated with an endovascular stent graft. In a 77-year-old man ureteral J-stents were placed for bilateral hydronephrosis due to retroperitoneal fibrosis caused by an inflammatory AAA. The aneurysm was treated with an endovascular aortic-bifemoral stent graft. Three months later, the patient suffered from severe hypovolemic shock. Emergency angiography showed a fistula between the right ureter and the right common iliac artery just distal to the right leg of the stent graft. The ureteroiliac fistula was treated with a wall graft (10F). The patient recovered well and remained asymptomatic. Ureteroiliac fistula remains a rare complication of ureteral stenting. Several risk factors have been described before. This case emphazes the increased risk of an arterial-ureteral fistula due to an indwelling ureteral stent and an inflammatory AAA, especially in combination with an additional stent graft for this inflammatory AAA.

Iliac-ureteral fistulas (IUF) are a rare but potential life threatening event and an important cause of gross hematuria. We report on three cases of IUF. In all cases, prior chronic ureteral stenting, extended pelvic surgery or pelvic irradiation had been performed. Diagnosis was confirmed with angiography in one case, in the others a CT scan revealed the IUF. Treatment included surgical exploration with local reconstruction, extra-anatomical bypass and nephrectomy with arterial patch repair. The increasing incidence of IUF is a consequence of an increasing number of advanced and extended pelvic operations, radiation therapy and long-term ureteral stenting. Diagnosis should be made by provocative angiography or CT. Treatment options vary depending on the site and morphology of the local situation, but morbidity and mortality is still high due to delayed adequate diagnosis and treatment. A conclusive algorithm should be followed for the successful management of IUF.

Objectives: To review the diagnosis and treatment of ureteroarterial fistulas and to develop a management algorithm. Long-term ureteral stenting, along with pelvic surgery and radiotherapy, have led to an increased incidence of ureteroarterial fistulas. Experience diagnosing and treating these fistulas has been limited to case reports., Methods: A retrospective chart review from 1975 to 2004 revealed eight ureteroarterial fistulas in 7 patients at our institution. The patient demographics, presenting symptoms, and diagnostic studies were reviewed. Also, we analyzed the treatment, hospital course, and long-term outcomes., Results: Ureteroarterial fistulas were more common in women (86%) than in men. All patients presented with gross hematuria, and 57% had lateralizing flank pain. Risk factors included chronic indwelling stents (87%), previous pelvic external beam radiotherapy (71%), pelvic surgery (100%), and vascular disease (87%). Provocative angiography was diagnostic in only 63% of cases. Although not sensitive, cystoscopy revealed lateralized, pulsatile hematuria in all cases when performed. Treatment ranged from endovascular stenting with nephrostomy tube to primary surgical repair with nephrectomy., Conclusions: On the basis of this review, we propose a systematic diagnostic and treatment approach to a serious disease process. The use of these proposed algorithms will minimize unnecessary testing, increase the speed of diagnosis, and potentially improve overall outcomes of patients with ureteroarterial fistulas.

Formation of an artery-to-ureter fistula (AUF) is a rare event caused by pelvic surgery or ureteral instrumentation. This presentation details the unique occurrence and treatment of simultaneous bilateral iliac artery-to-ureter fistulae. A 55-year-old man developed significant arterial hemorrhage during ureteral stent removal initially from the right and, subsequently, from the left side. Following expedient ureteral balloon tamponade, endovascular management via femoral approach with vein-covered stents was successful for each fistula without adverse long-term effects. Endoluminal therapy using autologous tissue-covered stents represents a simple, yet durable, treatment option in these challenging cases.

A 71-year-old woman who had undergone a total abdominal hysterectomy and pelvic irradiation for cervical cancer and fecal diversion for adhesive ileus was referred to us for a "left" ureteral stone and intermittent gross hematuria. Bilateral ureteral stents had been indwelled because of lower ureteral strictures for a long time. Hematuria continued after the removal of the ureteral stone, and she once went into hypovolemic shock at the time of exchange of the right ureteral catheter. Selective arteriography revealed a "right" ueteroarterial fistula. Endovascular management alone failed to resolve the fistula, but a subsequent transurethral metal coil embolization was effective, and the hematuria was relieved. She is still free from disease at 7-month followup. As far as we know, there has been no previous report of a transurethrally managed ureteroarterial fistula.

Ureteral-arterial fistulas are rare causes of intermittent and often massive hematuria. We report the case of a patient presenting with massive hematuria and shock caused by a ureteral-iliac fistula initially treated with a covered endovascular stent graft. Eight months after deployment, the stent occluded, and the patient required a femoral-femoral bypass. This is the first known case of endovascular stent graft occlusion when used for this purpose.

Two patients with the rare entity of arterio-ureteral fistula are presented. Both highlight the predisposing factors of radiation, major surgery in the region, history of vascular surgery and presence of double-J-stent. Both patients presented with the clinical sign of intermittent gross hematuria. Both patients were successfully treated by endovascular intervention using graft covered stent.

Presentation of case of patient with macroscopic anemic hematuria caused for the presence of a fistula between the external iliac artery and the ureter. After the diagnosis, a treatment with endovascular mangement was made. The arterioureteral fistulae are a very rare entie, which supposes a vital emergency. The diagnosis depend upon the clinical evidences (complementary explorations rarely provide specific findings). Classic treatment is bases on open surgery, while endovascular treatment may be an alternative with less aggressiveness.

Uretero-arterial fistulas are exceptional complications: only about forty cases have been reported in the literature. The authors report new two cases of fistula between the common iliac artery and the ureter. One fistula occurred in a context of prolonged ureteric stenting after radiotherapy and pelvic surgery for cancer of the uterus, and the other occurred after an aorto-bifemoral allograft. These fistulas generally occur in a particular clinical context, associating several aetiological factors. The clinical presentation is dominated by often massive and intermittent haematuria. The most useful diagnostic examinations are retrograde ureteropyelography and arteriography. The proposed treatment options (nephrectomy, vascular bypass graft and even embolization) depend on the urgency of the situation and involve both the blood vessel and the urinary tract. The prognosis depends on early diagnosis, but preventive measures can be envisaged to decrease the risk of appearance of these fistulas in high-risk patients.

Ureteroarterial fistulas, although rare, appear to be increasing in frequency. Because open surgical repair may be difficult and associated with significant risk for complications, endovascular intervention may provide an attractive treatment alternative. We review the diagnosis and management of a ureteroarterial fistula and iliac pseudoaneurysm that presented with massive hematuria during ureteral stent removal. The patient was treated by means of the percutaneous embolization of the right hypogastric artery and placement of an expanded polytetrafluoroethylene stent-graft. Endovascular stent-graft placement may serve as a safe and practical alternative in the treatment of these patients, whose cases are challenging.

Purpose: We describe an effective multidisciplinary approach to the diagnosis and management of ureteroarterial fistulas that reduces morbidity and mortality., Materials and Methods: Five ureteroarterial fistulas in 4 patients were studied with standard and provocative arteriography (arteriography combined with ureteral manipulation). After establishing the diagnosis, each lesion was treated with percutaneous embolic occlusion of the common iliac artery followed by extraanatomic arterial bypass grafting. All patients had chronic ureteral stenting, prior pelvic irradiation, prior pelvic surgery and intrapelvic malignancy, and all fistulas presented with urinary tract hemorrhage., Results: Standard arteriography was nondiagnostic but provocative arteriography demonstrated the fistula in each case. Successful embolization of the common iliac artery followed by extraanatomic arterial bypass grafting precluded the need for laparotomy and preserved ipsilateral renal function., Conclusions: Provocative arteriography followed by arteriographic common iliac artery embolization and extraanatomic bypass grafting was successful for the diagnosis and treatment of ureteroarterial fistulas. There was no mortality, limb loss or renal loss.

Ureteroarterial fistulae are rare. We report 2 cases of this clinical problem. Ureteroarterial fistulae can occur in association with prolonged ureteral stenting, radiation therapy, vascular pathology, and prior pelvic or vascular surgery. Identification of a fistula is often difficult and requires the physician to be highly alert and vigilant. Diagnostic and therapeutic options for a ureteroarterial fistula are discussed.

Objective: Fistulas between the iliac artery and the ureter are extremely uncommon, life-threatening conditions usually seen in patients who have had pelvic irradiation or have indwelling ureteral stents. We describe our experience in the angiographic evaluation and therapy of these fistulas., Materials and Methods: We retrospectively reviewed medical records for diagnoses of ureteroarterial fistulas. Patients' records were evaluated for potentially associated etiologic factors, clinical features and course, radiographic evaluation and findings, and therapy., Results: Our review showed that four patients treated at our institution (all since 1990) had ureteroarterial fistulas. All four patients had indwelling ureteral stents and had had irradiation for pelvic cancer. Three had spontaneous brisk hemorrhage in the urinary tract. The fourth had hemorrhage after balloon dilatation of a ureteral stricture. Initial diagnosis was based on findings on iliac arteriography in three patients and on findings on retrograde ureterography in one. Angiographic techniques required to visualize the fistulas included selective arterial catheterization, use of multiple projections, and provocative maneuvers. Treatment of the ureteroarterial fistulas involved surgery in one case, isolated embolotherapy in one case, and a combination of embolotherapy and surgery in two cases., Conclusion: Specific angiographic maneuvers are often required to identify ureteroarterial fistulas. Transcatheter embolotherapy (with or without surgical bypass) is an effective form of treatment for this rare abnormality.

Ureteroarterial fistulae (UAF) are a rare complication of prolonged ureteral stenting. To date only three patients have been reported who have developed UAF after pelvic exenteration. This report presents two additional patients with UAF following exenteration and prolonged ureteral stenting. Rapid diagnosis with pelvic arteriography and retrograde ureteral angioplasty balloon catheter placement is discussed, and successful management with femoral artery embolization and bypass surgery is reviewed.

A case is presented in which a patient with a gunshot wound in the abdomen sustained a traumatic arterio-ureteral fistula with resultant continual output of bloody fluid from the urethral catheter in the absence of any real production of urine. It is important to recognize the possibility of false reassurance regarding the patient's general status by supposing fluid thus produced to be an indication of actual urine formation.

We report on a patient with a fistula between the right common iliac artery and the distal right ureter who had undergone pelvic exenteration for carcinoma of the uterine cervix. The patient also had received prior radiation therapy and was being treated with an indwelling ureteral stent at the time the fistula developed. Diagnosis was made by an occlusive ureterogram and the lesion was treated successfully with embolization of the common iliac artery.