Pseudoaneurysm with arteriovenous fistula of the prostate after pelvic trauma: Ultrasound imaging

Abstract

Pseudoaneurysm (PA) associated with an arteriovenous fistula (AVF) of the internal pudendal artery branches are very uncommon. We report a case of post-traumatic PA with AVF connected to Santorini plexus. Diagnosis was made with trans-rectal ultrasound (TRUS) after recurrent hematuria. TRUS reported a 1.7 × 1.4 × 1.5 cm anechoic area, on anterior prostate apex close to Santorini plexus. The use of color Doppler in this area revealed high flow velocity that was indicative for AVF. The feeding artery was a distal branch of the left pudenda artery. After selective embolization was observed complete occlusion of the feeding branches and disappearance of PA with AVF. Prostate PA with concomitant symptomatic AVF detected with TRUS has not yet described in literature after pelvic trauma and represents complex diagnostic challenges. This case report suggests that the use of TURS and color Doppler can provide an important diagnostic and follow-up to address the clinical suspicion of occult vascular injuries using a noninvasive approach.

Postinfrapubectomy extruded Bone wax as cause of recurrent urethral polyp formation after progressive perineal urethroplasty: a rare scenario

“…Therefore, the performance of ultrasound rules out that any post-traumatic arteriovenous fistula or pseudoaneurysm is safe and very important before the transurethral approach to urethral polyps. 5 To the best of our knowledge, our case is the first such reported case of postinfrapubectomy bone wax-induced recurrent urethral polyp, resulting in splaying of urine stream after redoing PPU.…”

Late Arteriovenous Fistula after transurethral resection of the prostate: case report

“…Pelvic vascular lesions, such as pseudoaneurysms and arteriovenous fistulas (AVF), related to internal pudendal arteries after prostate procedures, are rare events. The main causes are trauma, including iatrogenic injuries, and disease, infection, or inflammation, which lead to endothelial dysfunction and damage in the vessel wall [2]. Congenital arteriovenous malformations are an even more rare entity that originate from arrest of embryonic developments resulting in anomalous vascular structures [3].…”

“…The surgical approach of these complications is challenging due to the complex anatomical location, which makes endovascular approach the most suitable treatment. In the medical literature, there few reports of similar cases in which patients developed pseudoaneurysms and AVFs after prostatic procedures which were effectively treated using endovascular techniques: Galosi et al, describes a case report of pseudoaneurysm with arteriovenous fistula after a pelvic trauma, diagnosed by trans-rectal ultrasound after patient exhibited recurrent hematuria [2]. Although surgical treatment is an option, it is associated with a higher mortality rate, therefore, embolization of the AVF was the chosen treatment [2][4].…”

Italian experiences in the management of andrological patients at the time of Coronavirus pandemic

“…In the first 50 days we had to intervene on two traumas of the genital tract that happened due to working activities. We listed criteria to plan andrological surgery in agreement with our experience, the Covid Task Force Unit in our hospital and published Guidelines on urological surgery (17)(18)(19)(20)(21). The andrological surgical activity included two orchiectomies for testicular cancer, one penile amputation with inguinal and ipsilateral pelvic lymph node dissection for penile cancer (Figure 4) and one surgery for severe gangrenous necrotizing fasciitis of the genitals in a 58-year male with diabetes, HIV and drugs addiction.…”