An unusual case of recurrent massive urethral bleeding following Optilume urethral dilatation needing selective embolisation of the bleeding vessel.

Optilume is a novel drug-coated balloon (DCB) that combines mechanical urethral dilatation with localised delivery of paclitaxel, an anti-proliferative agent aimed at reducing stricture recurrence. We report a rare complication in a 49-year-old man who had a urethral stricture treated with buccal mucosal graft urethroplasty abroad 6 years ago, followed by recurrence of ∼3cm mid-bulbar urethral stricture managed at another hospital with Optilume balloon dilatation. Post-procedure, he developed recurrent episodes of significant urethral bleeding needing multiple visits to the emergency unit. Subsequently, a computed tomography angiogram revealed an active arterial haemorrhage in the base of the penis, most likely arising from the left internal pudendal artery. The bleeding was successfully managed with super-selective embolisation using microcoils, preserving surrounding vascular structures. This case highlights the potential for serious vascular injury with DCB use and underscores the importance of preoperative counselling, careful technique and close postoperative monitoring. It further emphasises the role of microcoil embolisation as a targeted and effective approach for controlling complex urethral bleeding.