Iatrogenic ureteroarterial fistula treated by the placement of Allium stent: a case report and literature review.

Background: Ureteroarterial fistula (UAF) is a rare yet potentially life-threatening condition, which is challenging for urologists. It is traditionally treated by open surgical repair and endovascular repair. Intraureteral repair (IUR) was also previously reported, however all at the expense of normal kidney function. Here we present a case of unexpected UAF during urologic procedure which was successfully treated by a self-expanding Allium ureteral stent. Case Description: A 62-year-old woman diagnosed with bilateral ureteral stricture was admitted into our hospital for Allium stents insertion. However, she encountered an intraoperative emergency of UAF after ureteral balloon dilatation with presentation of urinary tract hemorrhage and hemodynamic instability. After consulting vascular surgeons, a clinical diagnosis of UAF was made. Three Allium stents were inserted in series. Urinary tract hemorrhage subsided immediately and circulation stability was quickly restored. Moreover, hydronephrosis was significantly relieved. No further hemorrhage occurred in the following 3 years. Conclusions: Allium ureteral stent could be a feasible option for patients with UAF and should be considered by urologists. Our experience suggests that IUR with Allium stent could plug UAF effectively in an emergent setting. In addition, it preserves normal kidney function satisfactorily. Base on such merits, Allium stent provides a real possibility for IUR of UAF, which could potentially change the current treatment guideline.