Spontaneous Bilateral Vesical Artery Pseudoaneurysms Presenting With Massive Recurrent Hematuria and Obstructive...

Spontaneous development of vesical artery pseudoaneurysm (VA-PA) as a cause of life-threatening hematuria is very rare. Most of the existing reports are due to trauma or other types of pelvic surgeries/urological procedures. Incomplete hemostasis in these patients can lead to subsequent complications such as clot retention, severe blood loss resulting in anemia and obstructive AKI. We report this extremely rare case of a 35 year old lady with bilateral VA-PA causing recurrent episodes of massive hematuria and obstructive AKI that was ultimately resolved by selective embolization. A 35-year-old female presented with a history of gross hematuria along with clot retention and severe anemia. She also had signs of obstructive AKI which required her to have temporary dialysis. Cystoscopy showed intravesical clot but no bleed site was identified on initial evaluation. On contrast-enhanced CT scan, there were pseudoaneurysms found from both sides coming off from left superior and right inferior branches of vesical artery. Following confirmation by selective pelvic angiogram, we did a superselective embolization using micro coils and PVOH particles to occlude both pseudoaneurysms. This resulted in immediate cessation of hematuria, normalization of renal functions and stabilization of Hb values. At last follow-up done in 6 weeks' time, all symptoms had resolved and there was complete thrombosis of both the lesions seen on imaging. Bilateral spontaneous vesical artery pseudoaneurysm is a condition that must be suspected in a patient presenting with recurrent episodes of severe hematuria despite having undergone seemingly successful endoscopic treatment. Immediate imaging of the vessels and selective angioembolization is the surest means of diagnosis and treatment, thus avoiding further complications.