Introduction: Urethral pseudoaneurysm is a rare condition, the few case reports available relate its occurrence to pelvic trauma and related to the chronic use of a urinary catheter, in which the prolonged contact of the device to the mucosa, leads to necrosis and subsequent vascular injury. This condition usually manifests as persistent urethral bleeding, the presentation of uncontrollable urethrorrhagia is even rarer. Transurethral coagulation and superselective embolization are possible options to treat these patients, but the best management option is still not well established. The objective of this video is to present an effective treatment for urethral pseudoaneurysm in a patient undergoing chronic use of an indwelling urinary catheter (IUC). Methods: A 37-year-old male with a neurogenic lower urinary tract dysfunction after spinal cord injury 5 years ago, using an IUC since the accident and no follow-up with urology. He was referred to the emergency after an episode of profuse urethral bleeding. It started after the routine catheter replacement. On clinical examination, there was gross hematuria in the collection bag. At first, we managed him conservatively with intravenous fluids and tranexamic acid injections, bed rest, and perineal compression dressing, but no sustained response was obtained. Transfusion of 4 red blood cell concentrates was required. We referred the patient to the operating room for flexible urethroscopy, which showed a friable hyperemic nodular lesion on the right lateral wall of the bulbar urethra. Magnetic resonance imaging (MRI) was performed considering the possibility of neoplastic injury and identified a hypervascularized polypoid lesion compatible with a pseudoaneurysm. Due to persistent bleeding, the patient was referred for arteriography, which visualized arterial blush arising from the transition between the internal pudendal artery and the bulbourethral artery. Selective embolization of the internal pudendal artery was performed with micro coils and cyanoacrylate successfully. Results: There was a sustained improvement in bleeding after the procedure. The patient was discharged after 24 hours of observation, the IUC was removed in seven days and the patient started clean intermittent catheterization. On our follow-up for more than two months with no fresh bleeding. Conclusions: In the case of a pseudoaneurysm of the internal pudendal artery causing urethrorrhagia, endovascular embolization is an effective method to control the bleeding if conservative management fails. SOURCE OF Funding: None.
