Abstract
Arterioureteral fistula (AUF) is a rare and life-threatening pathologic condition. Risk factors most commonly include chronic indwelling ureteral stents or a history of pelvic radiation. We present a case of a 58-year-old female who presented with catastrophic gross hematuria who was ultimately diagnosed with an (AUF) secondary to infected, eroded spinal hardware in her left mid ureter. This case highlights the importance of considering AUF in patients without traditional risk factors and underscores the diagnostic challenges posed by this rare but critical entity.