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Paper text:
pseudoaneurysms and arteriovenous fistulas ( avf ) associated with the internal pudendal artery are unusual .
we report the first case of recurrent haematuria in postoperative period caused by internal pudendal artery pseudoaneurysm with avf secondary to transvesical prostatic adenomectomy ( tpa ) .
there were no intraoperative complications . on the 5 postoperative day , after removal of the foley catheter , the patient presented recurrent episodes of gross hematuria with a bladder full of clots and anemia that required blood transfusion .
cystoscopy for clot evacuation showed a haematoma caused by arterial bleeding from the left side of the prostatic fossa .
the patient underwent computed tomography ( ct ) , which revealed a 2.2  1.5 cm hypervascular lesion matching the density of the adjacent iliac vessels on the left side of the residual prostate gland [ figure 1 ] .
a 4 french ( fr ) angiographic catheter was inserted via the left femoral artery and left internal iliac arteriography showed a pseudoaneurysm approximately 2 cm in size with venous filling during the early arterial phase , located at the distal portion of the left internal pudendal artery suggesting an avf [ figure 2a ] .
the left internal pudendal artery was catheterized super selectively with a 2.7 fr microcatheter and embolization was carried out using two micro coils 3 mm  40 mm [ figure 2b ] . after the procedure , the patient had no hematuria and was discharged after 3 days . at 6 months
pelvic computed tomography sagittal image with contrast shows a 2.2 cm  1.5 cm hypervascular component matching the density of the adjacent iliac vessels ( yellow arrow ) near the left residual prostate gland ( a ) selective left internal iliac artery injection revealed a pseudoaneurysm ( yellow arrow ) associated with arteriovenous fistulas ( venous filling in the early arterial phase ) ; ( b ) the left internal pudendal artery was catheterized ( 2.7 french microcatheter ) and embolized with microcoils ( yellow arrow )
a pseudoaneurysm is a single layer of fibrous tissue shaped like a sac containing a turbulent blood flow .
arterial pseudoaneurysms are formed after disruption in the vascular wall continuity and may be caused by trauma , inflammation , cancers , and iatrogenic causes .
the main iatrogenic causes are access for endovascular procedures , surgical procedures , and biopsies .
the major complications of pseudoaneurysms are rupture , embolization of a thrombus , infection , pain , and compression of adjacent structures .
we identified 6 published cases in the literature describing the management of this rare complication after radical prostatectomy or transurethral resection of the prostate .
however , angiography is the reference standard for diagnosis and has the advantage of allowing simultanneosu therapeutic intervention .
this case report confirms that trans - arterial embolization is an efficient way of managing postoperative bleeding due to prostatic surgery , preventing further surgical exploration .
pseudoaneurysms associated with the internal pudendal artery is rare and may occur as a complication of prostatic surgery or or pelvic trauma . 
 we present images of the first case in literature of an isolated pseudoaneurysm secondary to transvesical prostatic adenomectomy , which was successfully treated by transarterial coil embolization . 
 this complication can be difficult to diagnose , manage , and cause significant postoperative bleeding . 
 management requires as a multidisciplinary approach .