奇美醫學中心 外科部 泌尿科
Urethral trauma with repeated massive urethrorrhagia solved by transarterial embolization
Shih-Meng Huang,Chye-Yang Lim, Steven K. Huang
Division of Urology,Department of Surgery,Chi Mei Medical Center,Tainan,Taiwan
Urethrorrhagia is bleeding from the urethra due to calculus,inflammation, infection, trauma or Iatrogenic cause. In most of cases, it goes away by itself without treatment and repeated urethrorrhagia is less.
This 22-year-old male without systemic disease was admitted to our emergency department after a blunt perineal trauma due to a traffic accident. Urethrorrhagia was noted and urethrography revealed urethral injury at bulbous urethra, with near-complete disruption. Suprapubic cystostomy was done initially for urinary diversion. The Multi-detector computed tomography showed penile trauma with injury of corpora cavernosum and corpus spongiosum. The angiography showed a focal perforation at branch of right penile artery with bleeding into cavernous sponginosum,so transcatheter arterial embolization(TAE) with injection of gelfoam pieces into bleeding vessels was performed. Also,retrograde recanalization with Foley placement was done by the radiologist. However,repeated intermittent urethrorrhagia was noted in the following 3 days. The 2nd angiography revealed recurrent bleeding from right penile artery into cavernous sponginosum and cavernosum ,so TAE with gelatin sponges and microcoil was done. Urethrorrhagia arrested quickly and Foley drainage was kept without hematuria. After being discharged,erectile function was preserved during 6-months follow-up,but urethral stricture was noted by cystoscopy. After optic urethrotomy and sounding for twice,his voiding was smooth and PVR was 0ml.
The bulbar urethra is the most common site of anterior urethral blunt injury which was due to the bulb is compressed against the pubic symphysis. The common symptoms and signs are blood at the meatus,hematuria,pain on urination and penile or perineal swelling. This case presented urethrorrhagia and swelling of scrotum and penis but the rectal examination showed no obvious high-riding prostate. The retrograde urethrography was still the gold standard which showed near-complete rupture. Urinary diversion with urethral Foley for 3weeks was done according to the EAU guideline. Also,TAE was performed twice due to recurrent urethrorrhagia for right penile artery active bleeding. In previous case
reports,conservative treatment initially including hemostatic drugs,or external perineal or mechanical internal compression with urinary catheter was suggested for vascular ingury. TAE was also a good alternatives.
Conclusion:This case was anterior urethral blunt trauma with near-complete disruption and repeat urethrorrhagia which was solved by transcatheter arterial embolization twice and urinary diversion.