Bleeding without fracture: Unmasking a penile arterial leak as a cause of urethrorrhagia

Isolated urethrorrhagia during erection is rare and may suggest penile fracture or urethral rupture. We report a 39-year-old man using exogenous testosterone who presented with recurrent urethral bleeding during intercourse, without external trauma or urinary symptoms. Flexible urethroscopy showed a small focal mucosal defect, and dynamic penile MRI demonstrated a 4 mm periurethral hematoma with early arterial extravasation from a perforator branch of the left centro-cavernosal artery, without tunical rupture or pseudoaneurysm. Given clinical stability and spontaneous cessation of bleeding, conservative treatment was chosen, with good functional recovery and complete healing at 3 months.