Muhamad Fakhurrazi bin Mohamad Bakri Mashitah Ismail Zainal Effendy Zainal Abidin






Leech infestation is common in rural areas. In tropical climates, working in wetlands or swimming in streams infested by leeches falls as most common victims. Leeches usually infested body surface of host, but very rarely enter through body orifices of genitourinary tract. We report a case of a boy with leech infestation in urethra complicated with profuse haematuria followed by acute urinary retention.




While swimming in a waterfall in rural area, a 12 years old boy noticed a leech entering his penis and successful manually extracted the leech. Post manual extraction he presented with penile pain and profuse haematuria.


In emergency department, patient developed abdominal distension, urinary retention with palpable bladder. After urinary catheter insertion, gross haematuria was observed. IV tranexamic acid 1g was given. Bedside ultrasonography revealed distended bladder with multiple echogenic components within bladder consistent with organized blood clots.


Haematuria continued until the next 5 days despite bladder irrigation. Patient was not anemic and no blood product transfusion was required.


Cystoscopy reveals multiple redness patches over bladder wall with no leech seen. After 1 week of admission, patient was discharge well with antibiotics.



Leech bites on exposed skin are common. Urethra is a rare site for leech infestation.

Patient may present with severe penile pain, frank haematuria and urinary retention.

The duration of bleeding from leech bite was reported as 10 hours in a study.

Diagnosis can be suggestive if patient recognized that leech enter his urethra. Ultrasonography may be diagnostic. Cystoscopy can be diagnostic and therapeutic.

In most cases, bleeding stops spontaneously in few hours. Systemic hemostatic agents may be considered to stop bleeding as in our case.




Urethral hirudiniasis is an emergency. Early removal of leech, post bite bleeding control and treatment of infection can be potentially life saving.



Leech infestation, Heamaturia, Acute urinary retention

1) White GB, Leeches and leech infestation.In: Cook GC, editor. Manson's tropical diseases. London; Saunders 1998; 20; 1523-5
2) Faust EC, Russel PF, JUrg RC, Craig and Faust's clinical parasitology. Philadelphia: Lea and Febiger 1970;8:563-70
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