A bulbar artery pseudoaneurysm following traumatic urethral catheterization

Abstract

Cite as: Can Urol Assoc J 2017;11(1-2):E47-9. http://dx.doi.org/10.5489/cuaj.4050 Published online January 12, 2017 AbstractTraumatic urethral catheterization may result in a number of serious complications. A rare occurrence is the development of a urethral pseudoaneurysm. We report the case of a 13-year-old male who required placement of a Foley catheter for an orthopedic surgical procedure. The Foley was misplaced in the bulbourethra, resulting in the development of a bulbar artery pseudoaneurysm. Profuse bleeding via the urethra was noted after removal of the catheter, and the patient experienced severe intermittent hematuria during the postoperative period. Cystoscopy revealed a pulsatile mass within the bulbourethra. Angiography confirmed a bulbar artery pseudoaneurysm, which was successfully embolized with resolution of bleeding.

Case – The folly of a misplaced Foley

“…2 Even more exceedingly rare, pseudoaneurysm development of the arterial supply of the urethra from a Foley injury have seldom been reported. [3][4][5] It is thought that pressure necrosis of the urethral wall from the Foley balloon is the main culprit of these arterial malformations. 3 There are only three other reported cases of urethrorrhagia from a bleeding pseudoaneurysm due to Foley malposition, [3][4][5] and review of these cases are pertinent in order to accurately diagnose and manage this rare condition.…”

“…6 Bettez et al (2017) highlighted in their case a cystoscopic diagnosis of a pulsatile mass within the bulbar urethra. 5 Regardless of diagnostic strategy, it is imperative to have prompt and timely recognition of this complication.…”

“…(Figure 2) Success with coiling was found in all three reports. [3][4][5] We elected to keep our patient's Foley catheter for 2 weeks to allow for subsequent urethral healing, and removal of the catheter yielded no bleeding. Other authors have elected to utilize suprapubic catherization for 6 weeks with follow up urethrogram to rule out stricture formation.…”

Pseudoaneurysma der bulbären Harnröhre nach traumatischer Katheterisierung

“…Um die Gefahr einer späteren Harnröhrenstriktur zu reduzieren, war unserer Ansicht nach die superselektive Embolisation die geeignetere Therapie. In Medline fanden sich insgesamt drei publizierte Fälle [1,3,4], bei denen bisher eine Embolisation eines Astes der A. pudenda interna nach Bildung eines Pseudoaneurysmas erfolgte. In allen Fällen konnte dieser Eingriff komplikationslos durchgeführt werden und die Blutungsquelle erfolgreich ausgeschaltet werden.…”

Massive Urethral Bleeding Following Urethral Catheterization Induced by a Pseudoaneurysm

“…Differential diagnosis for urethral hematuria includes urethral tumor, stone, trauma, fistula, malformation or aneurysm. 1 Contrast-enhanced CT scan was performed as the choice of diagnostic tool for urethral bleeding. The result is shown in Figure 1.…”