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Date Published: 21/04/2026
Abstract Views: 0
DOI: 10.47972/vjcts.v55i.1730
Issue
Vol. 55
Section
Research Article
How to Cite
Tran, Q. T., Dang, V. H., & Do, K. Q. (2026). Complex urethral arterial injury following turp: combined coil and NBCA embolization for pseudoaneurysm and arteriospongious fistula: A case report. The Vietnam Journal of Cardiovascular and Thoracic Surgery, 55. https://doi.org/10.47972/vjcts.v55i.1730

Complex urethral arterial injury following turp: combined coil and NBCA embolization for pseudoaneurysm and arteriospongious fistula: A case report

Quy Tuong Tran1, , Vinh Hiep Dang, Kim Que Do1
1 Pham Ngoc Thach University of Medicine

Main Article Content

Abstract

Background
Vascular injury following transurethral resection of the prostate (TURP) is uncommon but may result in recurrent and potentially severe hematuria. While pseudoaneurysm of the internal pudendal or urethral artery has been reported, arteriospongious fistula remains a rare and underrecognized cause of post-surgical bleeding.

Case presentation: An 88-year-old male with a history of TURP five years earlier presented with recurrent episodes of gross hematuria requiring repeated endoscopic hemostasis. Two months prior to admission, he experienced another episode of massive hematuria despite prior transurethral coagulation. Contrast-enhanced CT demonstrated a left-sided urethral arterial pseudoaneurysm associated with dilatation of the cavernosal and urethral arteries and a urethral artery–corpus spongiosum fistula.

Diagnostic angiography confirmed hypervascularity of the left internal pudendal artery with a pseudoaneurysm and arteriospongious fistula. Super-selective endovascular treatment was performed via right femoral access. The cavernosal branch was embolized using a detachable microcoil 3mm-8cm (Interlock, Boston, USA) to reduce high-flow shunting, followed by selective embolization of the urethral artery fistulous branch using N-butyl cyanoacrylate (NBCA) mixed with Lipiodol (1:3). The dorsal penile artery and perineal branches were preserved.

Post-procedural angiography demonstrated complete occlusion of the pseudoaneurysm and fistula without non-target embolization. Hematuria resolved immediately, and no signs of penile or pelvic ischemia were observed. The patient was discharged in stable condition.

Conclusions: Delayed vascular injury after TURP may present as a combination of pseudoaneurysm and arteriospongious fistula, leading to recurrent hematuria. Super-selective endovascular embolization using a combined coil and NBCA strategy allows definitive and safe treatment while preserving critical penile arterial supply. Early recognition and targeted embolization are essential for durable hemostasis.

Keywords

Urethral artery pseudoaneurysm, Arteriospongious fistula, Recurrent hematuria, Endovascular embolization

Article Details

References

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