221 JOURNAL OF ENDOUROLOGY Volume 17, Number 4, May 2003 © Mary Ann Liebert, Inc. Iliac Artery Aneurysm: A Fatal Cause of Urinary Retention KHURSHID A. GURU, M.B.B.S., RICHARD C. SARLE, M.D., DANIEL REDDY, M.D., and JAMES O. PEABODY, M.D. ABSTRACT Our institution recently encountered two patients with ruptured iliac artery aneurysms. The first patient died, but as a result of our increased awareness, the second patient’s aneurysm was diagnosed immediately and op- erated on successfully. The urologic findings provided subtle clues to this life-threatening condition. We pres- ent these two cases with the hope that urologic surgeons will include this condition in their differential diag- nosis when evaluating patients with uncharacteristic abdominal pain and urinary symptoms. INTRODUCTION T WO PATIENTS WITH ILIAC ARTERY ANEURYSMS were admitted to the Emergency Department at Henry Ford Hospital within a period of 4 weeks. The Urology Department was consulted each time for evaluation of urinary retention. CASE REPORTS Patient 1 A 76-year-old man was admitted to the general surgery ser- vice with complaints of abdominal pain and inability to void. Earlier, prostate cancer had been treated with radiation, and the serum PSA concentration had been stable at 2.7 ng/mL. Phys- icalexaminationrevealedmoderatehypogastrictendernesswith no mass. A Foley catheter was inserted, draining 300 mL of urine. His serum creatinine concentration was elevated to 3.3 mg/mL. A non-contrast CT scan, performed to rule out di- verticulitis, revealed a large mass deep in the pelvis that was thought to be arising from the prostate or sigmoid colon, with the Foley balloon pushed to the right side of the pelvis (Fig. 1). Cystoscopyrevealedposteriorexternalcompressionof the blad- der from the pelvic mass and no bladder lesion. The mass was found to be extraprostatic on transrectal ultrasonography.That evening, prior to any additional diagnostic studies, the patient rapidly decompensated and died of cardiac arrest. An autopsy identified a ruptured internal iliac artery aneurysm. Patient 2 Four weeks after Patient 1 was seen, a 71-year old man was evaluated in the Emergency Department with complaints of lower abdominalpain associatedwith urinary frequencyand in- termittent gross hematuria for 2 days. These symptoms were thought to be secondary to urinary retention. A Foley catheter was placed, but the suprapubic distention failed to diminish. The Urology Service was consulted for evaluation of urinary retention. The catheter irrigated freely. Genitourinary exami- nation revealed a normal prostate and no rectal masses. A CT scan revealed a 18 3 13-cm mass deep in the pelvis causing deviation of the Foley catheter to the right side, with bilateral dilation of the ureters (Fig. 2). Because of our heightened suspicion as a result of the pre- vious case, and on further review of the CT scan, an urgent vascular surgery consultation was requested for evaluation of possible ruptured internal iliac artery aneurysm. The vascu- Vattikuti Urology Institute, Henry Ford Hospital, Detroit, Michigan. FIG. 1. Noncontrast CT scan in Patient 1 demonstrates large pelvic mass arising from or adjacent to prostate (white arrows). Note position of Foley catheter in distorted bladder (black arrow).