Massive Bleed Following Optical Internal Urethrotomy: An Unforeseen Doom Discussing the Unique Management Technique

To demonstrate the unique management technique of ultrasound (USG)-guided compression repair for bulbourethral artery pseudoaneurysm following optical internal urethrotomy (OIU) for short segment bulbar urethral stricture. A 40-year-old man underwent day care OIU for short segment bulbar urethral stricture. The procedure was uneventful and the patient was discharged the same day. After catheter removal on day 7, the patient had massive bleed from urethra. Perineal compression stopped the bleeding; however, the patient bled again and needed blood transfusion. CT angiography revealed right bulbourethral artery pseudoaneurysm. USG colour Doppler was performed to find out the exact site of pseudoaneurysm, and focused compression was given for 25 minutes. Later assessment showed no flow in pseudoaneurysm and tract was obliterated. Minor bleed following OIU is quite common and generally subsides spontaneously or with pressure dressing. Massive bleed is uncommon, although reported in the literature, and requires angioembolization of the feeding vessel. Before going for invasive procedure, this simple technique of USG-guided compression can be tried as it is simple, cost-effective, and highly successful in small pseudoaneurysm.