Posttraumatic urethral hemorrhage associated with an arteriospongious fistula and managed with catheter-directed embolization: a report of 2 cases.

Background: Urethral bleeding can be related to iatrogenic and non-iatrogenic trauma; selective internal iliac angiography may identify contrast extravasation with or without a pseudoaneurysm at the level of the distal internal pudendal or bulbourethral artery. Here, we describe another, yet unreported vascular lesion of the bulbourethral artery related to urethral injury.

Case presentation: Two patients with a iatrogenic and non-iatrogenic urethral bleeding respectively are presented. Conservative management, including Foley catheter placement and endoscopic management were unsuccessful. Selective internal pudendal angiography revealed an arteriospongious fistula without clear contrast extravasation into the urethral lumen; super-selective embolization with microcoils and non-adhesive liquid embolics was safely performed and successfully stopped the bleeding. The postinterventional course was uneventful and both patients recovered without sequelae.

Conclusions: Traumatic urethral bleeding might be related to an arteriospongious fistula which can be successfully managed with super-selective coil and liquid embolic embolization.