Massive upper tract hematuria following decompression of chronic PUJ obstruction: A rare but clinically significant complication

Hematuria after urinary decompression is common in chronic lower urinary tract obstruction but rarely originates from the upper tract. We report a 58-year-old woman with long-standing PUJ obstruction who developed massive renal pelvic hemorrhage following DJ stent placement. She presented with gross hematuria, hemoglobin drop, hypertension, and imaging showing a large renal pelvic clot. Conservative management stabilized her, and delayed surgery corrected the obstruction. This case highlights upper tract decompression hematuria as a rare yet potentially life-threatening complication requiring prompt recognition and careful management.