1
|
Donati-Bourne JF, Morris S, Nour S, McCafferty IJ, Smith Y. Successful embolisation of pelvic fistulating vessels to the prostate arising after TURP - a rare cause of postoperative bleeding. Ann R Coll Surg Engl 2019; 102:e60-e62. [PMID: 31660769 DOI: 10.1308/rcsann.2019.0149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Transurethral resection of the prostate (TURP) is considered the gold-standard operation to treat lower urinary tract symptoms due to benign prostatic enlargement in men. Postoperative bleeding is a recognised complication and managing it is a core skill required by attending urologists. We report a rare case of postoperative bleeding caused by fistulating vessels to the prostate which developed after TURP. These fistulas arose from the right internal iliac vessels and communicated with pre-existing pelvic varices affecting the right paraprostaticand seminal vesicle tissues. The fistulating vessels were successfully embolised with liquid embolic agent. Surgeons should be aware that persisting haemorrhage can occur post-TURP from the rare presence of fistulating vessels communicating with pelvic varices. Early computed tomography angiographic assessment is warranted in cases where bleeding is prolonged and refractory to standard management in view of timely referral for percutaneous embolisation.
Collapse
Affiliation(s)
- J F Donati-Bourne
- Department of Urology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - S Morris
- Department of Urology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - S Nour
- Department of Medicine, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK
| | - I J McCafferty
- Department of Radiology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Y Smith
- Department of Urology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| |
Collapse
|
2
|
Nunes RLV, Antunes AA, Constantin DS. Contemporary surgical treatment of benign prostatic hyperplasia. Rev Assoc Med Bras (1992) 2017; 63:711-716. [PMID: 28977110 DOI: 10.1590/1806-9282.63.08.711] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Accepted: 07/21/2017] [Indexed: 11/22/2022] Open
Abstract
Benign prostatic hyperplasia (BPH) is a common condition in adult men and its incidence increases progressively with aging. It has an important impact on the individual's physical and mental health and its natural progression can lead to serious pathological situations. Although the initial treatment is pharmacological, except in specific situations, the tendency of disease progression causes a considerable portion of the patients to require surgical treatment. In this case, there are several options available today in the therapeutic armamentarium. Among the options, established techniques, such as open surgery and endoscopic resection using monopolar energy, still prevail in the choice of surgeons because they are more accessible, both from a socioeconomic standpoint in the vast majority of medical services and in terms of training of medical teams. On the other hand, new techniques and technologies arise sequentially in order to minimize aggression, surgical time, recovery and complications, optimizing results related to the efficacy/safety dyad. Each of these techniques has its own peculiarities regarding availability due to cost, learning curve and scientific consolidation in order to achieve recognition as a cutting-edge method in the medical field. The use of bipolar energy in endoscopic resection of the prostate, laser vaporization and enucleation techniques, and videolaparoscopy are examples of new options that have successfully traced this path. Robot-assisted surgery has gained a lot of space in the last decade, but it still needs to dodge the trade barrier. Other techniques and technologies will need to pass the test of time to be able to conquer their space in this growing market.
Collapse
Affiliation(s)
- Ricardo Luís Vita Nunes
- Head of the Benign Prostatic Hyperplasia Department, Sociedade Brasileira de Urologia (SBU). Assistant Physician, Division of Urology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP). Head of the Urology Clinic, Hospital Militar de Área de São Paulo - Exército Brasileiro, São Paulo, SP, Brazil
| | - Alberto Azoubel Antunes
- Associate Professor, Division of Urology, Head of the Urology Graduate Program, and Coordinator of the Prostate Sector, Division of Urology, FMUSP, São Paulo, SP, Brazil
| | - Davi Souza Constantin
- Preceptor of Urology, Centro de Referência do Homem do Hospital de Transplantes Euryclides de Jesus Zerbini. MD, Urologist, Hospital Militar de Área de São Paulo - Exército Brasileiro, São Paulo, SP, Brazil
| |
Collapse
|
3
|
Mirakhur A, McWilliams JP. Prostate Artery Embolization for Benign Prostatic Hyperplasia: Current Status. Can Assoc Radiol J 2016; 68:84-89. [PMID: 27887933 DOI: 10.1016/j.carj.2016.06.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2016] [Revised: 05/04/2016] [Accepted: 06/18/2016] [Indexed: 11/17/2022] Open
Abstract
Prostate artery embolization has garnered much attention as a promising treatment for lower urinary tract symptoms secondary to benign prostatic hyperplasia. We aim to provide an up-to-date review of this minimally invasive technique, including discussion of potential benefits and technical challenges. Current evidence suggests it is a safe and effective option for patients with medication-refractory urinary obstructive symptoms who are poor surgical candidates or refuse surgical therapy. Larger, randomized studies with long-term follow-up data are needed for this technique to be formally established in the treatment paradigm for benign prostatic hyperplasia.
Collapse
Affiliation(s)
- Anirudh Mirakhur
- Division of Interventional Radiology, Department of Radiological Sciences, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, USA
| | - Justin P McWilliams
- Division of Interventional Radiology, Department of Radiological Sciences, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, USA.
| |
Collapse
|
4
|
Yu H, Isaacson AJ, Burke CT. Review of Current Literature for Prostatic Artery Embolization. Semin Intervent Radiol 2016; 33:231-5. [PMID: 27582611 DOI: 10.1055/s-0036-1586141] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Prostatic artery embolization (PAE) is an emerging, novel interventional technique in the management of patients with lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH). BPH is a common clinical condition in middle-aged and elderly men resulting in LUTS, including nocturia, urinary frequency, urgency, decreased urinary flow rates, hesitancy, and incomplete bladder emptying. Traditionally, LUTSs have been managed by medical or surgical therapies. Since the initial incidental discovery that selective PAE performed for uncontrolled bleeding secondary to BPH resulted in improved LUTS, the technique has continually evolved with a growing body of evidence supporting its safety and efficacy. However, despite the available data, PAE has yet to be established as a standard-of-care treatment option for patients with LUTS/BPH. In this article, the authors review the history and current state of PAE, including published data from case reports, animal studies, retrospective/prospective cohort studies, and prospective randomized controlled trials.
Collapse
Affiliation(s)
- Hyeon Yu
- Division of Vascular and Interventional Radiology, Department of Radiology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Ari J Isaacson
- Division of Vascular and Interventional Radiology, Department of Radiology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Charles T Burke
- Division of Vascular and Interventional Radiology, Department of Radiology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| |
Collapse
|
5
|
Cornu JN, Herrmann T, Traxer O, Matlaga B. Prevention and Management Following Complications from Endourology Procedures. Eur Urol Focus 2016; 2:49-59. [DOI: 10.1016/j.euf.2016.03.014] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Revised: 03/23/2016] [Accepted: 03/24/2016] [Indexed: 01/10/2023]
|
6
|
Kably I, Pereira K, Chong W, Bhatia S. Prostate Artery Embolization (PAE) in the Management of Refractory Hematuria of Prostatic Origin Secondary to Iatrogenic Urological Trauma: A Safe and Effective Technique. Urology 2015; 88:218-21. [PMID: 26610676 DOI: 10.1016/j.urology.2015.10.025] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Revised: 10/20/2015] [Accepted: 10/26/2015] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Incidence of refractory hematuria of prostatic origin (RHPO) is extremely rare, with an iatrogenic etiology even rarer. When conservative methods fail to control bleeding, more invasive surgical methods are needed. In this article we describe our experience with prostatic artery embolization (PAE) as a minimally invasive alternative treatment option in patients with RHPO secondary to iatrogenic urologic trauma. TECHNICAL CONSIDERATIONS Three patients presented with RHPO. The etiologies were transurethral resection of prostate surgery, Foley catheter removal with a supratherapeutic international normalized ratio and self-traumatic Foley catheter removal respectively. Stepwise management with conservative and medical methods failed to control bleeding. Under local anesthesia and moderate sedation, bilateral PAE was performed via a right common femoral artery access and using cone beam computed tomography. An embolic mixture containing 300-500 um Embosphere® Microspheres (Biosphere Medical, Rockland, MA) was injected under fluoroscopic guidance until stasis was achieved. PAE using the described technique was a technical and clinical success in all three patients. Hematuria resolved within a period of 24 hours. There were no intra- or periprocedural complications. CONCLUSION PAE offers a reasonable option in treatment of RHPO, regardless of the cause and may be attempted prior to surgical techniques or sometimes in conjunction. Being minimally invasive and performed under local anesthesia, PAE is especially useful when excessive bleeding prevents adequate visualization of a bleeding source during cystoscopy and in the elderly age group with several comorbidities. An added advantage is the prostatic parenchymal ischemia leading to significant prostate volume reduction and alleviation of the obstructive symptoms.
Collapse
Affiliation(s)
- Isaam Kably
- Department of Interventional Radiology, Jackson Memorial Hospital/University of Miami Hospital, Miami, FL
| | - Keith Pereira
- Department of Interventional Radiology, Jackson Memorial Hospital/University of Miami Hospital, Miami, FL.
| | - William Chong
- Department of Urology, Jackson Memorial Hospital/University of Miami Hospital, Miami, FL
| | - Shivank Bhatia
- Department of Interventional Radiology, Jackson Memorial Hospital/University of Miami Hospital, Miami, FL
| |
Collapse
|
7
|
Magno C, Mucciardi G, Galì A, Pappalardo R, Lembo F, Anastasi G, Butticè S, Ascenti G, Lugnani F. Is whole gland salvage cryotherapy effective as palliative treatment of haematuria in patients with locally advanced prostate cancer? Results of a preliminary case series. Ther Adv Urol 2015; 7:235-40. [PMID: 26425138 DOI: 10.1177/1756287215585451] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES Locally advanced prostate cancer may cause several complications such as haematuria, bladder outlet obstruction, and renal failure due to the ureteral obstruction. Various treatments have been suggested, including radiotherapy, antifibrinolytics, bladder irrigation with alum solution, transurethral surgery and angioembolization, none of which have proven effectiveness. In the last years cryoablation has become a valid therapeutic option for prostate cancer. In our experience we used this 'new' technique as haemostatic therapy. METHODS We selected four patients with gross haematuria affected by locally advanced hormone refractory prostate cancer, who had already been treated with primary radiotherapy. We used third-generation cryotherapy: under ultrasonographic guidance, we inserted six cryoprobes, two in each of the vascular pedicles reaching at least -60°C, and three thermometers. We then induced two freeze-thaw cycles. RESULTS After the operation the haematuria stopped in all patients and at 9-month follow up we observed a mean of four red cells (range three to five) in the urinary sediment with no evidence of bacteriuria. Prostate volume, prostate-specific antigen and postmicturition residue were significantly reduced. Qmax improved significantly too. CONCLUSION Our experience has given us good results with minimal intra- and postoperative complications. We think that haemostatic cryotherapy as a palliative approach for locally advanced prostate cancer could represent a valid treatment option and more consideration could be given to its use.
Collapse
Affiliation(s)
- Carlo Magno
- Department of Human Phatology, Unit of Urology, University of Messina, Via C. Valeria 1, 98125 Messina, Italy
| | - Giuseppe Mucciardi
- Department of Human Pathology, Unit of Urology, University of Messina, Messina, Italy
| | - Alessandro Galì
- Department of Human Pathology, Unit of Urology, University of Messina, Messina, Italy
| | - Rosa Pappalardo
- Department of Human Pathology, Unit of Urology, University of Messina, Messina, Italy
| | - Francesco Lembo
- Department of Human Pathology, Unit of Urology, University of Messina, Messina, Italy
| | - Giuseppina Anastasi
- Department of Human Pathology, Unit of Urology, University of Messina, Messina, Italy
| | - Salvatore Butticè
- Department of Human Pathology, Unit of Urology, University of Messina, Messina, Italy
| | - Giorgio Ascenti
- Department of Radiology, University of Messina, Messina, Italy
| | - Franco Lugnani
- Unit of Urology, Kirurski Sanatorij Ljubljana Slovenia, Slovenia
| |
Collapse
|
8
|
Embolización prostática: un nuevo campo de actuación de la radiología intervencionista. ACTA ACUST UNITED AC 2014. [DOI: 10.1016/j.rard.2014.06.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
|
9
|
Clinical, laboratorial, and urodynamic findings of prostatic artery embolization for the treatment of urinary retention related to benign prostatic hyperplasia. A prospective single-center pilot study. Cardiovasc Intervent Radiol 2013; 36:978-86. [PMID: 23580116 DOI: 10.1007/s00270-013-0611-5] [Citation(s) in RCA: 71] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2013] [Accepted: 02/26/2013] [Indexed: 10/27/2022]
Abstract
PURPOSE This study was designed to describe the clinical, laboratorial, and urodynamic findings of prostatic artery embolization (PAE) in patients with urinary retention due to benign prostatic hyperplasia (BPH). METHODS A prospective study of 11 patients with urinary retention due to BPH was conducted. Patients underwent physical examination, prostate specific antigen (PSA) measurement, transrectal ultrasound, and magnetic resonance imaging. International prostate symptom score (IPSS), quality of life (QoL), and urodynamic testing were used to assess the outcome before and after 1 year. RESULTS Clinical success was 91% (10/11 patients) with a mean follow-up of 22.3 months (range, 12-41 months). At the first year follow-up, the mean IPSS score was 2.8 points (p = 0.04), mean QoL was 0.4 points (p = 0.001), mean PSA decreased from 10.1 to 4.3 ng/mL (p = 0.003), maximum urinary flow (Qmax) improved from 4.2 to 10.8 mL/sec (p = 0.009), and detrusor pressure (Pdet) decreased from 85.7 to 51.5 cm H2O (p = 0.007). Before PAE, Bladder Outlet Obstruction Index (BOOI) showed values >40 in 100% of patients. After PAE, 30% of patients were >40 (obstructed), 40% were between 20 and 40 (undetermined), and 30% were <20 (unobstructed). Patients with a BOOI <20 had higher PSA values at 1-day after PAE. CONCLUSIONS Clinical and urodynamic parameters improved significantly after PAE in patients with acute urinary retention due to BPH. Total PSA at day 1 after PAE was higher in patients with unobstructed values in pressure flow studies.
Collapse
|
10
|
Camara-Lopes G, Mattedi R, Antunes AA, Carnevale FC, Cerri GG, Srougi M, Alves VA, Leite KRM. The histology of prostate tissue following prostatic artery embolization for the treatment of benign prostatic hyperplasia. Int Braz J Urol 2013; 39:222-7. [DOI: 10.1590/s1677-5538.ibju.2013.02.11] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2012] [Accepted: 02/04/2013] [Indexed: 11/22/2022] Open
|
11
|
Cheng S, Xu L, Li G, Chen Y, Hu H, Zhang Z, Ding G. Superselective internal iliac arterial embolization for severe hemorrhage following radical prostatectomy. Oncol Lett 2012; 4:521-523. [PMID: 22970050 DOI: 10.3892/ol.2012.749] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2012] [Accepted: 05/24/2012] [Indexed: 11/06/2022] Open
Abstract
Severe hemorrhage following a prostatectomy is a rare and serious complication. A 63-year-old male with severe hemorrhage following radical prostatectomy which led to hypovolemic shock presented at our department and was treated with superselective internal iliac arterial embolization. At 6 months follow-up, the patient had recovered well, regained excellent urinary continence and the pelvic hematoma was absorbed using ultrasound examination. We concluded that rapid diagnosis by computed tomography angiography and early superselective embolization of internal iliac artery should be considered as the treatment of choice in severe hemorrhage cases following radical prostatectomy.
Collapse
Affiliation(s)
- Sheng Cheng
- Department of Urology, Sir Run Run Shaw Hospital, College of Medical Sciences, Zhejiang University, Hangzhou, Zhejiang 310016, P.R. China
| | | | | | | | | | | | | |
Collapse
|
12
|
Prostatic artery embolization as a primary treatment for benign prostatic hyperplasia: preliminary results in two patients. Cardiovasc Intervent Radiol 2009; 33:355-61. [PMID: 19908092 PMCID: PMC2841280 DOI: 10.1007/s00270-009-9727-z] [Citation(s) in RCA: 149] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2009] [Accepted: 09/23/2009] [Indexed: 12/24/2022]
Abstract
Symptomatic benign prostatic hyperplasia (BPH) typically occurs in the sixth and seventh decades, and the most frequent obstructive urinary symptoms are hesitancy, decreased urinary stream, sensation of incomplete emptying, nocturia, frequency, and urgency. Various medications, specifically 5-α-reductase inhibitors and selective α-blockers, can decrease the severity of the symptoms secondary to BPH, but prostatectomy is still considered to be the traditional method of management. We report the preliminary results for two patients with acute urinary retention due to BPH, successfully treated by prostate artery embolization (PAE). The patients were investigated using the International Prostate Symptom Score, by digital rectal examination, urodynamic testing, prostate biopsy, transrectal ultrasound (US), and magnetic resonance imaging (MRI). Uroflowmetry and postvoid residual urine volume complemented the investigation at 30, 90, and 180 days after PAE. The procedure was performed under local anesthesia; embolization of the prostate arteries was performed with a microcatheter and 300- to 500-μm microspheres using complete stasis as the end point. One patient was subjected to bilateral PAE and the other to unilateral PAE; they urinated spontaneously after removal of the urethral catheter, 15 and 10 days after the procedure, respectively. At 6-month follow-up, US and MRI revealed a prostate reduction of 39.7% and 47.8%, respectively, for the bilateral PAE and 25.5 and 27.8%, respectively, for the patient submitted to unilateral PAE. The early results, at 6-month follow-up, for the two patients with BPH show a promising potential alternative for treatment with PAE.
Collapse
|
13
|
Sun F, Sánchez FM, Crisóstomo V, Lima JR, Luis L, García-Martínez V, López-Sánchez C, Usón J, Maynar M. Benign Prostatic Hyperplasia: Transcatheter Arterial Embolization as Potential Treatment—Preliminary Study in Pigs. Radiology 2008; 246:783-9. [DOI: 10.1148/radiol.2463070647] [Citation(s) in RCA: 87] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
14
|
Popoola AA, Onawola KA, Adesina MD, Olaoye IO. Intestinal obstruction: a rare complication of channeling transurethral resection of the prostate (TURP): a case report. J Med Case Rep 2008; 2:30. [PMID: 18230150 PMCID: PMC2259370 DOI: 10.1186/1752-1947-2-30] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2007] [Accepted: 01/29/2008] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Channeling transurethral resection of the prostate is a recognized form of adjunctive treatment in the treatment of patients with prostate cancer. Despite the fact that complications arising from the procedure have been on the decline, rare complications like intestinal obstruction may occur. CASE PRESENTATION This is a case report of a 56 year old man who developed mechanical intestinal obstruction few days after a channeling TURP for advanced CaP. CONCLUSION The report highlights the possibility of intestinal obstruction as a secondary event following a silent urinary bladder perforation during channeling TURP. Early recognition and intervention were responsible for the good outcome in this patient.
Collapse
Affiliation(s)
- A A Popoola
- Urology Division, Department of Surgery, University of Ilorin Teaching Hospital, Ilorin, Nigeria.
| | | | | | | |
Collapse
|
15
|
Barrass BJR, Thurairaja R, McFarlane J, Persad RA. Haematuria in prostate cancer: new solutions for an old problem. BJU Int 2006; 97:900-2. [PMID: 16643466 DOI: 10.1111/j.1464-410x.2006.06121.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|