A Case Report of Suspected Bleeding Disorder of Unknown Cause and Review of Diagnostic Challenges in Unexplained Bleeding after Trans-Urethral Resection of Bladder Tumor

Bleeding disorder of unknown cause can cause significant bleeding after surgery. However, it is challenging to diagnose as a diagnosis of exclusion and is not well-described in urologic oncology. In this case report, we describe the first documented case of a patient with non-muscle invasive bladder cancer who experienced persistent hemorrhage after transurethral resection of bladder tumor (TURBT), was initially diagnosed with Factor XI deficiency, but was eventually found to likely have a bleeding disorder of unknown cause. He underwent diagnosis-guided treatment with tranexamic acid, ultimately leading to resolution of his bleeding and avoiding radical cystectomy. Given the lack of guidelines, we also provide a suggested preoperative and postoperative management approach for all patients undergoing TURBT with an abnormal bleeding history.