Pseudoaneurysm after Radical Prostatectomy: A Case Report and Narrative Literature Review

Abstract

(1) Background: We report a very unusual presentation of pseudoaneurysm developed following a robot-assisted radical prostatectomy (RARP) with bilateral pelvic lymph node dissection. The patient was a 66-year-old male, admitted at the Emergency Department 20 days after discharge from RARP due to chest pain, lipothymia and occult bleeding, necessitating a blood transfusion and a moderate increase of serum troponin. Angiography showed a pseudo-aneurysm involving the inferior-epigastric artery pubic branch. The patient underwent percutaneous embolization with complete resolution. The aim of this study is to offer an overview on pseudoaneurysms developed as radical prostatectomy complications; (2) Methods: A literature search was conducted on Scopus and PubMed for pseudoaneurysms after RARP to analyze all the previously published cases. The search terms used were “pseudoaneurysm” and “prostatectomy” using the Boolean Operator “AND”. We used the default search strategy “all fields”; (3) Results: Herein, a narrative review is proposed to facilitate the approach to this emerging clinical challenge, due to both an implementing in diagnosis imaging techniques and a spread of robotic surgery in prostate cancer; (4) Conclusions: The management of radical prostatectomy complications still remains barely uniformed and needs to be precisely calibrated as the initial cure approach itself.

Prostatic Fossa Pseudoaneurysm After Robot-Assisted Radical Prostatectomy (RARP): A Case Report

“…Older series reported open drainage was the most successful treatment, avoiding long-term functional outcomes of hematoma persistence, such as bladder neck contracture and long-term incontinence [ 4 , 5 ]. Nowadays, endovascular management is used in most of these hemorrhagic complications because it is less invasive, but the management approach depends on the vessel involved and the hemodynamic status [ 3 ]. Postprostatectomy pseudoaneurysms (PPP) are a very rare complication, with the most recent series showing only 23 cases described in the literature [ 3 ].…”

“…Hemorrhagic complications and hematuria in the perioperative period are rare [ 2 ], but they can be severe and prolong its morbidity. Prostatic fossa pseudoaneurysms have been described in the past with variable clinical presentations, most often with intermittent episodes of hematuria, with angioembolization being the preferred treatment modality [ 3 ]. Here, we describe a rare case of a pseudoaneurysm in the prostatic fossa as an early postoperative complication (<30 days) of RARP.…”

Intravesical Agents in the Treatment of Bladder Clots in Children

“…This review analyzed the restricted number of works published on this issue, with an exceedingly limited number of treated patients. The works focused on pediatric patients consisted only of case series and case reports, that conceptually play a key role mainly in stimulating hypotheses and new developments [ 38 ]. The retrospective and prospective analyzed studies did not include pediatric patients, therefore a generalization would be improper and arbitrary.…”

“…Actually, the low scientific value of the analyzed works does not allow one agent to be defined as preferable to another one: no clinical trials were found and no case-control studies have been carried out. The overinterpretation or incorrect comprehension of this type of work could lead to “anecdotal fallacy” [ 38 ]. The proposed overview of techniques aims to simplify topic comprehension.…”

Urethral Sheath to Evacuate Blood Clots through Mitrofanoff Appendicovesicostomy

“…Like most case reports, a generalization is not possible, and the clinical results may be different than the expected ones. Their overinterpretation or misinterpretation may induce an "anecdotal fallacy [19,20]".…”