Embolization with microcoils for urethral hemorrhage

Abstract

Rationale: Microcoils are a permanent embolic material, and blood vessels that have been embolized by a microcoil remain occluded for a prolonged period of time. The pudendal artery is an important functional vessel for penile erection. Whether simultaneous embolization of the bilateral pudendal artery using microcoils can seriously affect penile erection has not been sufficiently studied. Patient concerns: A 47-year-old male patient, after undergoing brain surgery, accidentally pulled out the Foley catheter causing a urethral hemorrhage. The patient was immediately treated using a new larger Foley catheter inserted under urethroscopic guidance and medication. However, massive bleeding occurred on the tenth day after the procedure. Diagnosis: A right internal iliac angiography performed after the bleeding event demonstrated a rupture at the end of the right internal pudendal artery with the contrast agent flowing out directly from the urethra. A super selective internal pudendal angiogram showed a small amount of hemorrhage at the end of the left internal pudendal artery. Interventions: The patient underwent interventional treatment. After the bilateral internal iliac angiography was performed, super-selective internal pudendal artery embolization with microcoils was performed. A subsequent bilateral internal pudendal angiogram did not show any abnormality. Outcomes: During the follow up period of 2 months, the patient had no complaints of difficulty in urination or sexual dysfunction. Lessons: Some doctors do not advocate the use of coils as embolic agents in bilateral pudendal artery lesions because of concerns over erectile dysfunction. There is rich vascular circulation in the perineum. Thus, in arterial embolization for the treatment of penile bleeding, regardless of the type of embolic material used, the key is to ensure accurate embolization to maintain good collateral circulation. This principle can help limit the occurrence of sexual dysfunction to the lowest possible levels after such procedures.

A singular case of massive urethrorrhagia solved by transarterial embolization

“…Angiography proved that DSA allows in more than 50% of cases to better identify the target vessel and the precise localization of active bleeding and extravasation of contrast agent, rather than conventional fluoroscopy, due to a better contrast resolution and proved, in addition, that sometimes the diagnosis can be missed owing for the lacked selectivity of the angiographic study performed [1].…”

“…Since the complexity of perineal arterial district, the use of embolic agents, temporary or permanent ones, requires adequate experience and training by the operators [1,19,20].…”

“…Urethrorrhagia is a clinical condition defined as a continuous or intermittent active bleeding from external urinary meatus, independent of urination, and so, it is different from hematuria; associated symptoms can be urinary burning or retention [1].…”

“…The therapeutic approach for urethrorrhagia depends on the different cases and it can be conservative, urethroscopic, endovascular, or surgical [1,10].…”

Pre-peritoneal Pelvic Pack with External Fixator versus Pelvic Pack Alone for Hemodynamically Unstable Patients with Pelvic Fracture; a Historical Cohort Study

“…The rst pack should put in the inferior part of Sacro-iliac joint, the second one should be placed in the anterior part of Pelvic edge and the last band should be in the retro pubic situation (8). Emergent arteriography and embolization would be mentioned, if hemorrhage is continuous (9).…”