This is an open access article under the terms of a license that permits non-commercial use, provided the original work is properly cited. © 2023 The Authors. Société Internationale d'Urologie Journal, published by the Société Internationale d'Urologie, Canada. SIUJ.ORG SIUJ • Volume 4, Number 4 • July 2023 Key Words Competing Interests Article Information Arteriovenous malformation, urethrorrhagia, catheter injury, haematuria, penile AVM None declared. Patient consent: Obtained. Received on December 14, 2022 Accepted on January 18, 2023 This article has been peer reviewed. Soc Int Urol J. 2023;4(4):347–348 DOI: 10.48083/FJOA1305 347 CLINICAL PICTURE Novel Finding of Lower Genital Tract Arteriovenous Malformation Leading to Massive Urethral Bleed Paul Kim, James Kovacic, Ankur Dhar, Andrew R.H. Shepherd Royal North Shore Hospital, Department of Urology, St Leonards, Australia A 68-year-old male was referred for management of transfusion-dependent haematuria after traumatic self-removal of indwelling catheter with inflated balloon. Haematuria recurred intermittently around and within catheter lumen and was exacerbated after each trial of void. Cystoscopy revealed urethral bleeding refractory to endoscopic coagulation. CT-angiogram demonstrated contrast extravasation in the left corpus spongiosum, suggestive of penile arte- riovenous malformation (AVM) (Figure 1A). Endovascular embolisation of the AVM with Gelfoam from the left internal pudendal artery (Figure 1B) was performed because of ongoing transfusion-dependent haematuria. Post- procedurally there was immediate resolution of haematuria, and the patient underwent successful trial of void. At a 9-month follow-up, there was no recurrence of haematuria, no priapism or de novo erectile dysfunction, and no palpable penile lumps. AVMs of the lower male genital tract are rare, with only a few case reports published[1]. Whilst the majority are paediatric cases of the scrotum and glans penis[2] they can also be acquired from traumatic catheter manipula- tion[3]. Endoscopic intervention is often the first-line therapy, but it is rarely successful, and an endovascular or open approach is usually required[1]. The endovascular approach carries a risk of erectile dysfunction if the internal puden- dal artery is compromised; however, favourable outcomes were identified in a small series of 10 patients[4]. In contrast, open approaches have been favoured in those with atraumatic aetiologies for their AVMs[2]. In this case, a minimally invasive approach has had a favourable outcome in a rare pathology with no standard treatment guidelines. References 1. White JT, Baverstock RJ. Eruption of blood: arteriovenous malformation of the penile urethra. Can Urol Assoc J.2017;11(1–2):E32–E34. 2. Houston N, Raghavan RS, Asghar AM, Morales-López RA, Metro MJ. Management of symptomatic adult penile urethral arteriovenous malformation. Urol Case Rep.2021;38:101738. 3. Francesco P, Milena C, Antonio B, Francesco G, Fabio C, Antonio C, et al. A singular case of massive urethrorrhagia solved by transarterial embolization. Egypt J Radiol Nucl Med.2020;51(1):1–7 4. Park HW, Her SH, Park BH, et al. Correlation between internal pudendal artery stenosis and erectile dysfunction in patients with suspected coronary artery disease. PLoS One.2019 Nov 12;14(11), e0225179. https://doi.org/10.1371/journal. pone.0225179. http://SIUJ.org mailto:paul.kim4%40health.nsw.gov.au?subject=SIUJ FIGURE 1A. CT mesenteric angiogram: coronal view in arterial phase demonstrating contrast leak into corpus spongiosum on the left-hand side FIGURE 1B. Coronal view from pre-embolisation angiography highlighting region of hypervascularity at base of the penis on the left side from the left internal pudendal artery 348 SIUJ • Volume 4, Number 4 • July 2023 SIUJ.ORG CLINICAL PICTURE http://SIUJ.org