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POD 21. (A) Loopogram showing extravasation from the ileal conduit with no contrast in the left ureter. (B) Antegrade left nephrostogram showing distal ureteral narrowing with anastomotic dehiscence. POD, post operative day.
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His postoperative course was complicated by an ileal conduit leak adjacent to the right ureteroileal anastomosis and a left ureteral conduit anastomotic dehiscence (Fig. 1), necessitating bilateral antegrade 12F ureteral stent insertion and bilateral nephrostomy tube placement by POD 30.
Left pullback nephrostogram showing contrast in the left common and external iliac artery. (A) Baseline. (B) Contrast in the left common iliac artery (black arrow).
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Left pullback nephrostogram showed a distal ureteral to the left common iliac artery fistula (Fig. 2).
(A) Pelvic angiogram showing active extravasation within the left common iliac artery near the origin of the left internal iliac artery and in proximity to the left retrograde ureteral stent (black line). (B) Completion angiography after deployment of 10 x 38 mm balloon-expandable atrium stent, 14 x 40 mm and 12 x 40 mm uncovered stents at the proximal and distal ends of atrium stent showing cessation of active extravasation. (C, D) Pullback nephrostogram 19 days poststent placement showing persistent fistula from the left ureter into the left common iliac artery. (A) Contrast extravasation (arrow). (B) Completion angiography. (C) Scout film. (D) Contrast in left common iliac artery (arrow).
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Pelvic angiography was emergently performed, showing active extravasation within the left common iliac artery (Fig. 3A). Completion angiography showed persistent filling at the site of previously noted extravasation, and two additional uncovered 14 x 40 mm and 12 x 40 mm stents were deployed at the proximal and distal ends of the atrium stent (Fig. 3B). Pullback nephrostogram of the left renal pelvis and ureter showed a persistent fistula from the left ureter to the left common iliac artery (Fig. 3C, D).