V07-09 URETHRAL PSEUDOANEURYSM CAUSING UNCONTROLLED URETHRORRHAGIA

Abstract

You have accessJournal of UrologyCME1 Apr 2023V07-09 URETHRAL PSEUDOANEURYSM CAUSING UNCONTROLLED URETHRORRHAGIA Fábio Franco de Oliveira, André Canettieri Rubez, João Marcos Ibrahim de Oliveira, Caio de Oliveira, Natalia Dalsanter Avilez, Jefferson Douglas Camargos Moreira, Gabriel Chahade Sibanto Simões, Ivan Borin Selegatto, Bruno Ricardo Di Domenico, Arthur Degani Ottoiano, Lucas Mira Gon, and Cássio Luís Zanettini Riccetto Fábio Franco de OliveiraFábio Franco de Oliveira More articles by this author , André Canettieri RubezAndré Canettieri Rubez More articles by this author , João Marcos Ibrahim de OliveiraJoão Marcos Ibrahim de Oliveira More articles by this author , Caio de OliveiraCaio de Oliveira More articles by this author , Natalia Dalsanter AvilezNatalia Dalsanter Avilez More articles by this author , Jefferson Douglas Camargos MoreiraJefferson Douglas Camargos Moreira More articles by this author , Gabriel Chahade Sibanto SimõesGabriel Chahade Sibanto Simões More articles by this author , Ivan Borin SelegattoIvan Borin Selegatto More articles by this author , Bruno Ricardo Di DomenicoBruno Ricardo Di Domenico More articles by this author , Arthur Degani OttoianoArthur Degani Ottoiano More articles by this author , Lucas Mira GonLucas Mira Gon More articles by this author , and Cássio Luís Zanettini RiccettoCássio Luís Zanettini Riccetto More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003288.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Urethral pseudoaneurysm is a rare condition, the few case reports available relate its occurrence to pelvic trauma and related to the chronic use of a urinary catheter, in which the prolonged contact of the device to the mucosa, leads to necrosis and subsequent vascular injury. This condition usually manifests as persistent urethral bleeding, the presentation of uncontrollable urethrorrhagia is even rarer. Transurethral coagulation and superselective embolization are possible options to treat these patients, but the best management option is still not well established. The objective of this video is to present an effective treatment for urethral pseudoaneurysm in a patient undergoing chronic use of an indwelling urinary catheter (IUC). METHODS: A 37-year-old male with a neurogenic lower urinary tract dysfunction after spinal cord injury 5 years ago, using an IUC since the accident and no follow-up with urology. He was referred to the emergency after an episode of profuse urethral bleeding. It started after the routine catheter replacement. On clinical examination, there was gross hematuria in the collection bag. At first, we managed him conservatively with intravenous fluids and tranexamic acid injections, bed rest, and perineal compression dressing, but no sustained response was obtained. Transfusion of 4 red blood cell concentrates was required. We referred the patient to the operating room for flexible urethroscopy, which showed a friable hyperemic nodular lesion on the right lateral wall of the bulbar urethra. Magnetic resonance imaging (MRI) was performed considering the possibility of neoplastic injury and identified a hypervascularized polypoid lesion compatible with a pseudoaneurysm. Due to persistent bleeding, the patient was referred for arteriography, which visualized arterial blush arising from the transition between the internal pudendal artery and the bulbourethral artery. Selective embolization of the internal pudendal artery was performed with micro coils and cyanoacrylate successfully. RESULTS: There was a sustained improvement in bleeding after the procedure. The patient was discharged after 24 hours of observation, the IUC was removed in seven days and the patient started clean intermittent catheterization. On our follow-up for more than two months with no fresh bleeding. CONCLUSIONS: In the case of a pseudoaneurysm of the internal pudendal artery causing urethrorrhagia, endovascular embolization is an effective method to control the bleeding if conservative management fails. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e598 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Fábio Franco de Oliveira More articles by this author André Canettieri Rubez More articles by this author João Marcos Ibrahim de Oliveira More articles by this author Caio de Oliveira More articles by this author Natalia Dalsanter Avilez More articles by this author Jefferson Douglas Camargos Moreira More articles by this author Gabriel Chahade Sibanto Simões More articles by this author Ivan Borin Selegatto More articles by this author Bruno Ricardo Di Domenico More articles by this author Arthur Degani Ottoiano More articles by this author Lucas Mira Gon More articles by this author Cássio Luís Zanettini Riccetto More articles by this author Expand All Advertisement PDF downloadLoading ...