Coexisting intrarenal arteriovenous and caliceovenous fistulae after percutaneous nephrolithotomy: Case report and literature review

A 58-year-old man was re-admitted to the Urology service with delayed gross hematuria and unstable hemodynamics, following a percutaneous nephrolithotomy (PCNL) procedure performed for an obstructive solitary left lower calyceal stone. A selective left renal angiogram demonstrated an interpolar arteriovenous fistula (AVF), which was treated with successful coil embolization of a sub-segmental feeding branch. Subsequent nephrostogram confirmed a coexisting caliceovenous fistula, which was observed and healed spontaneously. Iatrogenic coexisting intrarenal AVF and caliceovenous fistulae have never been reported and should be considered as a possible cause of delayed severe hematuria with unstable hemodynamics, and/or increase in baseline creatinine after PCNL.