Caño-Velasco Jorge, Herranz-Amo Felipe, González-Leyte Manuel, Barbas-Bernardos Guillermo, Molina Escudero Roberto, Polanco Pujol Lucía, Hernández-Fernández Carlos
Servicio de Urología. Hospital General Universitario Gregorio Marañón. Madrid. España.
Servicio de Radiología Vascular Intervencionista. Hospital General Universitario Gregorio Marañón. Madrid. España.
Arch Esp Urol. 2018 Dec;71(10):856-859.
Urethrorrhagia after radicalprostatectomy(RP) is very uncommon, regardless of the surgicalapproach used. Arterio-urethral fistula formation betweeninternal pudendal artery branches(IPA) and bulbarurethra is an exceptional finding.
We report what we consider the first series oftwo cases (one has already been published) of urethrorrhagiaafter open retropubic RP due to urethrovascular fistulaformation with its origin in the IPA or in one of its terminalbranches.
Both cases were diagnosed with contrast-enhancedCT, confirmed with arteriography, and they weretreated with superselective transarterial embolization(STE)with spongostan. After 5 years, the first case maintainserectile function using tadalafil on demand. The other caseis in the 2nd postoperative month.
Severe urethrorrhagia after RP is an exceptionalcomplication. The existence of an arterio-urethralfistula must be considered when both urethrorrhagia andabnormal bulbar enhancement in CT are present. Arteriographyallows to confirm the diagnosis, most frequently involvingIPA distal branches. STE is an effective and safetreatment.
