Transurethral resection of prostate (TURP) remains the gold standard surgical therapy for symptomatic benign prostatic enlargement, with reported International Prostate Symptom Score reduction of up to 70%. However, as many as 20% of patients can have significant complications including sexual dysfunction, perioperative bleeding requiring blood transfusion, and incontinence. Intractable hematuria from the prostate can be life-threatening, and its management remains a difficult clinical problem. Prostate artery embolization (PAE) is occasionally indicated in such patients when all other measures have failed. PAE has been used to treat benign prostatic hyperplasia; however, literature related to its use for bleeding following TURP remains limited. We report a case of an elderly male who presented with recurrent episodes of hematuria following TURP and was successfully treated by endovascular management.
Introduction: Prostate artery embolization is an emerging technique, that appears to be a promising option in the management of benign prostatic hyperplasia for patients unsuitable for surgery. Prostate artery embolization, similar to all other interventions, is not a suitable treatment for all patients with this disease. It is indicated as a minimally invasive option in patients unfit to undergo trans urethral resection of prostate.
Case Report: A 78-year-old male suffering from castrate resistant prostate cancer and on treatment with Abiraterone plus prednisolone presented to the Uro-oncological services of the hospital with difficulty to void, incomplete voiding, and sense of incomplete voiding. He had other medical co-morbidities which included Diabetes mellitus, hypertension, and ischaemic heart disease. His cardiac ejection fraction was 25% and was advised not to undergo any surgical procedure. Serum creatinine on admission was 2.2 mg% and serum PSA were 26.5 ng/ml. Under local anaesthesia, using retrograde Seldinger’s technique right common femoral arterial access was obtained and 6F vascular introducer sheath was placed. Bilateral pelvic angiogram was performed, each of the prostatic arteries was superselectively catheterized and the prostatic gland was embolized using PVA (polyvinyl alcohol) particles 200m. Post catheter removal the patient voided well with a maximum flow of 14.5 ml/sec.
Conclusion: Prostate artery embolization can successfully treat complications associated with prostate cancer such as LUTS, urinary retention and haematuria with a low risk of serious adverse events.
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