Arterial embolization for massive hematuria following transurethral prostatectomy
| Autor: | F. Cognet, Jean-Pierre Cercueil, Thomas Dubruille, Frédéric Michel, Denis Krausé, Philippe Paparel |
|---|---|
| Rok vydání: | 2002 |
| Předmět: |
Male
medicine.medical_specialty medicine.medical_treatment Urology Perforation (oil well) Prostatic Hyperplasia Hemorrhage urologic and male genital diseases Transurethral prostatectomy Medicine Humans Embolization Macroscopic hematuria Aged Hematuria medicine.diagnostic_test business.industry Prostatectomy Arterial Embolization Angiography Prostate Transurethral Resection of Prostate Cystoscopy Embolization Therapeutic female genital diseases and pregnancy complications Surgery Catheter business |
| Zdroj: | The Journal of urology. 168(6) |
| ISSN: | 0022-5347 |
| Popis: | The management of significant hematuria following transurethral prostatectomy is most frequently surgical. We report on a patient who benefited from arteriography with arterial embolization for severe hematuria following transurethral prostatectomy. This method is an interesting alternative to surgical intervention. CASE REPORT A 66-year-old man presented with incapacitating dysuria due to benign prostatic hyperplasia. -Blockers had had no effect on the symptoms. Rectal examination revealed a soft and regular prostate. Prostate specific antigen (PSA) was 1.1 ng./ml. (normal less than 4). Ultrasound showed a trabeculated bladder without upper tract dilatation, with a post-void residual urine volume of 100 ml. Prostatic volume was estimated at 30 gm. The patient underwent transurethral prostatectomy, during which 25 gm. prostatic tissue was resected. No gross bleeding or perforation of the prostatic capsule was noted during surgery. Postoperative course was uneventful with normal voiding following catheter ablation. At 25 days postoperatively the patient was hospitalized for macroscopic hematuria. Irrigation through the bladder catheter was initially successful. However, 4 days later massive hematuria recurred, with red blood draining through the catheter until hemodynamic compromise necessitated a transfusion. Cystoscopy was impossible due to the significant bleeding. Emergent arteriography demonstrated active bleeding through the prostatic branch of the left hypogastric artery. Superselective arteriography revealed bleeding from a capsular artery (fig. 1). This artery was embolized and the bleeding stopped (fig. 2). Post-arteriography followup was uncomplicated. Bladder catheter was removed on day 2 and the patient was discharged home the following day. He was seen again at 5 weeks and 1 year postoperatively, at which time he was voiding comfortably without macroscopic hematuria. |
| Databáze: | OpenAIRE |
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