Endovascular Management in a Case of Recurrent Bleed Following Transurethral Resection of the Prostate

Nerli, Rajendra B; Kadeli, Vishal; Mulimani, Naveen; Ghagane, Shridhar C

doi:10.4103/ajir.ajir_28_17

Cited by 4 publications

(3 citation statements)

References 5 publications

(10 reference statements)

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“…The authors concluded that palliative PAE was safe and efficient for treatment for LUTS associated with prostate cancer. In conclusion, PAE can successfully treat complications associated with prostate cancer such as LUTS, urinary retention and haematuria with a low risk of serious adverse events [15].…”

Section: Discussionmentioning

confidence: 91%

Prostate Artery Embolisation as a Palliative Care in a Patient with Prostate Cancer: A Case Report

Nerli¹,

Adhikari²,

Mulimani³

et al. 2021

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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 200m. 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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Section: Discussionmentioning

confidence: 91%

Prostate Artery Embolisation as a Palliative Care in a Patient with Prostate Cancer: A Case Report

Nerli¹,

Adhikari²,

Mulimani³

et al. 2021

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“…Endovascular management (transcatheter arterial embolisation), as studied in case reports, is considered a minimally invasive procedure in symptom palliation following the failure of conservative management of intractable haematuria originating from the prostate [72]. In a systematic review regarding palliative pelvic radiotherapy for symptom relief, pooled results showed a 73% reduction of haemorrhage [73].…”

Section: Recommendations For Management Of Site-specific Bleedingmentioning

confidence: 99%

Management of bleeding in palliative care patients in the general internal medicine ward: a systematic review

Sood¹,

Mancinetti

Betticher³

et al. 2020

Annals of Medicine and Surgery

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BackgroundPalliative care patients, those suffering from at least one chronic lifelong medical condition and hospice care patients, those with a life expectancy less than 6 months, are regularly hospitalised in general internal medicine wards. By means of a clinical case, this review aims to equip the internist with an approach to bleeding in this population. Firstly, practical advice on platelet transfusions will be provided. Secondly, the management of bleeding in site-specific situations will be addressed (from the ENT/pulmonary sphere, gastrointestinal - urogenital tract and cutaneous ulcers). Finally, an algorithm pertaining to the management of catastrophic bleeding is proposed.MethodsElectronic databases, including EMBASE, Pubmed, Google Scholar and the Cochrane Library were studied as primary resources, in association with local guidelines, to identify papers exploring platelet transfusions and alternative management of site-specific bleeding in palliative care patients.ResultsHaemorrhagic complications are frequent in palliative care patients in the internal medicine ward. Current guidelines propose a therapeutic-only platelet transfusion policy. Nonetheless, prophylactic and/or therapeutic transfusion remains a physician-dependent decision. Site-specific therapeutic options are based on expert opinion and case reports. While invasive measures may be pertinent in certain situations, their application must be compatible with patient goals. Catastrophic bleeding requires caregivers' comforting presence; pharmacological management is secondary.ConclusionLiterature is lacking regarding management of bleeding in the palliative care population hospitalised in an acute medical setting. Recommendations are of limited quality, the majority based on case reports or expert opinion. Further studies, exploring for example the impact on patient quality of life, are desirable to improve the management of this frequently encountered complication.

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“…Суперселективна артеріальна емболізація ПЗ вважається малоінвазивним хірургічним втручанням при паліативному лікуванні гематурії, джерелом якої є ПЗ [10]. У систематичному огляді показники зниження кровотечі досягнули 73% [11].…”

Section: клинический случай: успешное применение повторной суперселекunclassified

Clinical Case: Successful Use of Repeated Superselective Arterial Embolization in Metastatic Prostate Cancer Complicated by Bleeding

Головко

Балабаник

Кобірніченко

et al. 2020

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Національний військовий медичний клінічний центр «Головний військовий клінічний госпіталь», м. Київ Стійка гематурія, джерелом якої є новоутворення передміхурової залози (ПЗ), є потенційно небезпечний для життя стан, що посилює основні терапевтичні проблеми. Причинами вираженої гематурії найчастіше є рак передміхурової залози (РПЗ). Найбільш часто тяжкі рецидивуючі простатичні кровотечі виникають при вчасно нелікованих ураженнях та особливо при гормонрефрактерній формі раку. У багатьох хворих кровотеча не може бути повністю контрольована консервативними заходами, такими, як призначення рутинних гемостатичних препаратів, місцеве застосування холоду, дренування сечового міхура уретральним катетером з постійною іригацією його стерильними розчинами, інстиляції нітрату срібла чи ендоскопічна діатермія. Сьогодні «золотим стандартом» лікування локалізованого РПЗ є радикальна простатектомія. Однак радикальне оперативне втручання не завжди можливе, не дивлячись на високу ефективність, у зв'язку з різними обставинами, а саме: віком та обумовленим даним фактором супутніми захворюваннями, що підвищують анестезіологічний ризик. У такої групи хворих доцільно використовувати тазову ангіографію з емболізацією, яка виявилась безпечним та ефективним методом контролю кровотечі з ПЗ. Проте аналіз результатів зазначеної методики базується на даних клінічних випадків та невеликих, з обмеженою кількістю хворих, досліджень. Незважаючи на це, селективна артеріальна емболізація стала методом вибору при неефективності консервативних методів лікування. Ключові слова: рак передміхурової залози, гематурія, селективна артеріальна емболізація. Clinical case: successful use of repeated superselective arterial embolization in metastatic prostate cancer complicated by bleeding S. Golovko, V. Balabanik, A. Kobirnichenko, I. Troitskiy, V. Bondarchuk Persistent hematuria, the source of which is a neoplasm of the prostate gland, is a potentially life-threatening condition that exacerbates major therapeutic problems. The most common causes of severe hematuria are prostate cancer. Most often, severe recurrent prostatic bleeding occurs with untreated lesions and especially with hormone-refractory form of cancer. In many patients, bleeding cannot be completely controlled by conservative measures, such as routine hemostatic drugs, topical cold, urethral catheter drainage with permanent irrigation with sterile solutions, silver nitrate instillation, or endoscopic diathermy. Currently, the «gold standard» for the treatment of localized prostate cancer is radical prostatectomy. However, radical surgery is not always possible, despite the high efficiency, due to various circumstances, namely: age and due to this factor comorbidities that increase the risk of anesthesia. In this group of patients, it is advisable to use pelvic angiography with embolization, which proved to be a safe and effective method of controlling prostate bleeding. However, the analysis of the results of this technique is based on clinical cases and small, with a limited number of patients...

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Endovascular Management in a Case of Recurrent Bleed Following Transurethral Resection of the Prostate

Cited by 4 publications

References 5 publications

Prostate Artery Embolisation as a Palliative Care in a Patient with Prostate Cancer: A Case Report

Prostate Artery Embolisation as a Palliative Care in a Patient with Prostate Cancer: A Case Report

Management of bleeding in palliative care patients in the general internal medicine ward: a systematic review

Clinical Case: Successful Use of Repeated Superselective Arterial Embolization in Metastatic Prostate Cancer Complicated by Bleeding

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