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Posttraumatic high flow internal pudendal artery-urethral fistula
M Monga1, F A Puyau, W J Hellstrom
1Department of Urology, Tulane University School of Medicine, New Orleans, Louisiana.
The Journal of Urology
|March 1, 1995
Summary
A rare posttraumatic fistula between the internal pudendal artery and urethra caused severe hematuria after a car accident. Selective arterial embolization successfully treated this condition.
Area of Science:
- Urology
- Vascular Surgery
- Trauma Surgery
Background:
- Posttraumatic arteriovenous fistulas can occur after pelvic trauma.
- Gross hematuria is a concerning symptom requiring prompt diagnosis and management.
Observation:
- A patient presented with persistent, pulsatile gross hematuria and required transfusions after a motor vehicle accident.
- Associated injuries included a comminuted pubic ramus fracture.
Findings:
- Initial uroradiographic studies failed to pinpoint the source of bleeding.
- Selective angiography was crucial in diagnosing a fistula between the internal pudendal artery and the urethra.
- Selective arterial embolization of the internal pudendal artery achieved definitive treatment.
Implications:
- This case highlights the diagnostic utility of selective angiography in complex posttraumatic vascular injuries.
- Arterial embolization is an effective endovascular treatment for internal pudendal artery fistulas.
- Prompt recognition and management are vital for patients with severe posttraumatic hematuria.