Abstract
A 72-year old male presented with muscle invasive bladder cancer was counseled on the standard of care neoadjuvant chemotherapy and he started treatment. He then presented with anemia, blood in the stool and gas in the right renal pelvis and was diagnosed with Pyeloduodenal fistula. The fistula was treated with clipping by gastroenterology and the bladder tumor treated with robotic partial cystectomy.