Massive Urethral Bleeding Following Urethral Catheterization Induced by a Pseudoaneurysm

A 58-year-old male patient who had a history of benign prostate hyperplasia, presented with chronic urinary retention and admitted for urinary catheter exchange. There was profuse bleeding of about 1000 mL noticed from the urethra after the reinsertion of Foley Catheter. No tender lump palpable was detected based on the physical examination findings. The level of hemoglobin was declined from 103 g/L to 72 g/L. Following continuous bladder irrigation, fluid induction and blood transfusion were performed.

What would you do next?

(A) Ultrasonography of the urinary system

(B) Contrast-enhanced computed tomography (CT) scan and angiography

(C) X-Ray Pelvis

(D) Magnetic resonance urography

What to do next?

(B) Contrast-enhanced CT scan and angiography

In this case, patient with a history of massive urethral bleeding after urinary catheter exchange was presented. Differential diagnosis for urethral hematuria includes urethral tumor, stone, trauma, fistula, malformation or aneurysm. Contrast-enhanced CT scan was performed as the choice of diagnostic tool for urethral bleeding. The result is shown in Figure 1. The CT scan revealed a 1.5 × 2.2 cm pseudoaneurysm in the bulbar urethral. Bilateral internal iliac angiography confirmed the CT findings and revealed that the extravasation of contrast material was initiated at the right branch of the internal pudendal artery. Super selective catheterization of the right internal pudendal arteries and embolization were performed (Fig. 2). Urethral pseudoaneurysm of this patient was likely caused by the prolonged changes in perineal pressure, which might attributable to necrotic arterial wall formation resulted from timely replacement of urinary catheter. Although it is a rare complication of massive urethral bleeding, it is of paramount importance to control the bleeding promptly in order to avoid further devastating complications. Angiography and super selective embolization are highly sensitive and specific for the diagnosis and treatment of urethral pseudoaneurysm, despite the potential complications of erectile dysfunction and urethral stricture.^, In our case, urethral pseudoaneurysm was diagnosed accurately and successfully treated. There was no recurrence of gross hematuria and no post-operative complications were observed in this patient during the follow-up period.

Firstly, the authors would like to thank the patient for providing his consent to present his case and accompanying images for the publication of this case report. Secondly, the authors would like to express their gratitude to EditSprings (https://www.editsprings.cn/) for the expert linguistic services provided.