Urethral catheter induced pseudoaneurysm of the bulbar artery

Abstract

Injuries of the urethra due to urethral catheter have been well recognised. We report a case of pseudoaneurysm of the artery to the bulb of the penis which formed due to necrosis of the arterial wall secondary to prolonged pressure due to a wrongly placed urethral catheter. The catheter was inflated in the bulbar urethra and left during surgery for 4 hours. The patient developed intermittent severe urethral bleeding. An angiogram of internal iliac artery showed a pseudo aneurysm involving the bulbar artery with arteriovenous communication. Super selective embolization of the feeding vessel was performed with cessation of the blood flow immediately. To our knowledge, pseudoaneurysm of the bulbar artery of penis has not previously been described.

Perineal Pseudoaneurysm from Traumatic Foley Removal Leads to Recurrent Life-Threatening Hematuria

“…Pseudoaneurysms lead to a pressurized dilation of the vessel leading to invasion of potential spaces in surrounding tissues. 1 A pseudoaneurysm leading to life-threatening hematuria has been reported in one other case of catheter-induced trauma, 2 but there are a handful of cases of lower urinary tract pseudoaneurysms in the urologic literature that have been effectively treated with angioembolization. 1,3,4 In our case, the discovery of this pseudoaneurysm was unexpected but led to a good therapeutic solution.…”

A bulbar artery pseudoaneurysm following traumatic urethral catheterization

“…It has been hypothesized that the traumatic injury to the arterial wall is actually pressure necrosis produced by catheter balloon inflation within the urethra. 3 The etiology is plausible, but speculative and the exact cause for pseudoaneurysm formation remains unknown. Nevertheless, inflation of a urethral catheter balloon in the bulbar urethra for a prolonged period of time appears to be a risk factor for the development of a bulbar artery pseudoaneurysm.…”

“…2 A single case of a bulbar pseudoaneurysm has been reported in an adult. 3 The symptomatology of pseudoaneurysms is variable. The natural history is thrombosis, progression or rupture.…”

Foley catheter insertion into a kidney

“…A few case reports showed iatrogenic complications of UC, including dilating the catheter bulb before the tip had entered the bladder, leading to the rupture of the urethra (Buddha, ), pseudoaneurysm of the artery to the bulb of the penis which formed due to necrosis of the arterial wall secondary to prolonged pressure due to a wrongly placed urethral catheter (Radhakrishnan et al ., ), and Fournier's gangrene of the scrotum following traumatic UC (Conn and Lewi, ). In addition, there are a few case reports which describe perforation of the bladder related to indwelling Foley catheter (Almgren et al ., ; Merguerian et al ., ; White et al ., ; Farraye and Seaberg, ).…”