A singular case of massive urethrorrhagia solved by transarterial embolization

Pane Francesco,Coppola Milena,Silvestre Mattia,Borzelli Antonio,Giurazza Francesco,Corvino Antonio,Corvino Fabio,Niola Raffaella

doi:10.1186/s43055-020-00299-8

Abstract

BackgroundUrethrorrhagia is frequent in pelvic trauma, rarely due to traumatic injuries of internal pudendal artery branches.Case presentationOur aim is to underline the role of transarterial embolization in selected patients, as in this case in which a young man manifested urethral hemorrhage after high-energy motorcycle crash not associated with injuries of the inferior urinary tract. Multi-detector computed tomography (MDCT) showed pubic symphysis diastasis and perineal hematoma with pseudoaneurysm into the penis bulb. The first approach was conservative with perineal external compression and intravenous injection of tranexamic acid. Afterward, due to the decline of clinical conditions, we decided to perform a selective angiography, confirming the vascular injury of distal branches of both internal pudendal arteries with contrast agent extravasation into urethral bulb; endovascular embolization was performed with detachable micro-coils. The principal results were seen quickly, indeed urethrorrhagia arrested and hemoglobin values normalized. Erectile function was preserved at 6-months follow-up.ConclusionsEndovascular embolization proved to be a minimally invasive therapeutic approach, clinically effective, with a low rate of complications and high probability to preserve erectile function.

Highlights

Urethrorrhagia is frequent in pelvic trauma, rarely due to traumatic injuries of internal pudendal artery branches.Case presentation: Our aim is to underline the role of transarterial embolization in selected patients, as in this case in which a young man manifested urethral hemorrhage after high-energy motorcycle crash not associated with injuries of the inferior urinary tract
A key role can be played by transcatheter endovascular embolization (TAE), representing a valid choice and mini-invasive effective treatment compared with other “invasive” approaches, ensuring a brief recovery time
We report and discuss the case of a young man with massive urethrorrhagia due to a pseudoaneurysm successfully treated with TAE thanks to prompt and correct management

Summary

Introduction

Urethrorrhagia is frequent in pelvic trauma, rarely due to traumatic injuries of internal pudendal artery branches.Case presentation: Our aim is to underline the role of transarterial embolization in selected patients, as in this case in which a young man manifested urethral hemorrhage after high-energy motorcycle crash not associated with injuries of the inferior urinary tract. Urethrorrhagia is frequent in pelvic trauma, rarely due to traumatic injuries of internal pudendal artery branches. Urethral traumatic lesions require a urologic approach, while rarely a vascular lesion (pseudoaneurysm or fistula) can be found in the correspondence of distal branches of the hypogastric artery (internal pudendal or obturator arteries). In these cases, a key role can be played by transcatheter endovascular embolization (TAE), representing a valid choice and mini-invasive effective treatment compared with other “invasive” approaches, ensuring a brief recovery time. We report and discuss the case of a young man with massive urethrorrhagia due to a pseudoaneurysm successfully treated with TAE thanks to prompt and correct management

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