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

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.