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Case Reports in Urology
Volume 2015, Article ID 646784, 4 pages
Case Report

Management of Delayed Onset Postoperative Hemorrhage after Anastomotic Urethroplasty

1Department of Urology, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, 3RCP, Iowa City, IA 52242, USA
2Department of Urology, University of Minnesota, 420 Delaware Street, SE b435, Minneapolis, MN 55455, USA
3Department of Urology, University of California San Francisco, 1001 Potrero Avenue, SFGH 3, San Francisco, CA 94110, USA

Received 20 August 2015; Accepted 25 October 2015

Academic Editor: Giorgio Carmignani

Copyright © 2015 L. A. Bertrand et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Excision with primary anastomosis (EPA) urethroplasty is generally the preferred method for short strictures in the bulbar urethra, given its high success rate and low complication rate compared to other surgical interventions. Bleeding is a presumed risk factor for any surgical procedure but perioperative hemorrhage after an EPA requiring hospitalization and/or reintervention is unreported with no known consensus on the best course for management. Through our experience with three separate cases of significant postoperative urethral hemorrhage after EPA, we developed an algorithm for treatment beginning with conservative management and progressing through endoscopic and open techniques, as well as consideration of embolization by interventional radiology. All the three of these cases were managed successfully though they did require multiple interventions. We theorize that younger patients with more robust corpus spongiosum and more vigorous spontaneous erections, patients that have undergone fewer prior urethral procedures and therefore have more prominent vasculature, and those patients managed with a two-layer closure of the ventral urethra without ligation of the transected bulbar arteries are at a higher risk for this complication.