Life-threatening Bleeding After Optical Internal Urethrotomy: Successfully Managed by Super- Selective Angioembolization, a Case Report and Review of Literature

Minor bleeding after internal urethrotomy is quite common and often subsides spontaneously. Mild to moderate persistent bleeding responds well with conservative management. Severe, life-threatening bleeding that necessitates invasive intervention is seldom seen these days. Selective or super-selective angioembolization is highly effective in these cases and has minimal associated morbidity. Here, we present a case of refractory urethral bleeding after optical internal urethrotomy (OIU) successfully managed by super-selective angioembolization. A 59-year-old man was referred to us with massive pericather bleeding after a cold knife internal urethrotomy done at a peripheral center 5 days ago. There was recurrent clot retention and a clinically significant drop in hemoglobin while on conservative management. Two units of LDPRBC were transfused. There was no history of chronic liver or kidney disease or any coagulation disorders. After Initial conservative measures failed, the patient underwent a computed tomography angiogram of the pelvis, which revealed a pseudoaneurysm arising from the bulbourethral artery. Different invasive management approaches like endoscopic fulguration, angioembolization, and open surgical repair have been explained and discussed with the patient and their relatives. Following shared decision-making and informed consent, angioembolization of the bulbourethral artery was performed. The bleeding stopped after the procedure, and the patient was discharged after 24 hours of observation. The present report highlights the use of super-selective embolization in severe urethral bleeding if initial conservative measures failed.