Intractable hematuria due to giant prostatic hyperplasia effectively treated with prostatic artery embolization

doi:10.1016/j.ajur.2019.06.002

Asian Journal of Urology, 2020, 7 (3): 318-321 doi: 10.1016/j.ajur.2019.06.002

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Intractable hematuria due to giant prostatic hyperplasia effectively treated with prostatic artery embolization

Issam Kably^a,b,Alexander Bode^a,*(

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^a Jackson Memorial Hospital, Department of Vascular and Interventional Radiology (R-109), PO Box 016960, Miami, FL, USA
^b University of Miami Leonard M. Miller School of Medicine, 1600 NW 10th Ave #1140, Miami, FL, USA

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Abstract

Giant prostatic hyperplasia (GPH) is a rare pathology traditionally treated with an open suprapubic prostatectomy. This procedure is risky, and fatal hemorrhagic complications can occur. Often, patients with GPH present with diminished renal function due to obstructive nephropathy, making them unfit for less invasive endovascular therapies using traditional contrast agents. Here we present a case of a patient with intractable hematuria due to GPH, as well as diminished renal function, who was successfully treated using prostatic artery embolization with CO₂ digital subtraction arteriography as a contrast agent.

Key words： Hematuria Embolization Giant prostatic hyperplasia

Received: 01 March 2018 Available online: 20 July 2020

Corresponding Authors: Alexander Bode E-mail: adb127@med.miami.edu

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Cite this article:

Issam Kably,Alexander Bode. Intractable hematuria due to giant prostatic hyperplasia effectively treated with prostatic artery embolization[J]. Asian Journal of Urology, 2020, 7(3): 318-321.

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http://www.ajurology.com/EN/10.1016/j.ajur.2019.06.002 OR http://www.ajurology.com/EN/Y2020/V7/I3/318

Pre-PAE CT demonstrating giant prostate. (A) Pre-procedural CT scan demonstrated massively enlarged prostate gland (thin arrows) with a Foley catheter in place. Hyperdense material seen in the bladder lumen (asterisk) was consistent with ostensible blood product. The iliac artery bifurcation (thick arrow) was noted on pre-procedural imaging to avoid initial pelvic runoff with injection of iodinated contrast media; (B) Manual segmentation on the volumetric cone beam CT images yielded a prostate volume of 724 mL. PAE, prostatic artery embolization; CT, computed tomography.

CO₂ digitally subtracted angiography (DSA) visualization of the left internal iliac and iodinated contrast confirmation of variant anatomy. (A) CO₂ DSA of the left internal iliac artery in a 45-degree ipsilateral oblique demonstrated the origin of the left prostate artery (thin black arrow) originating from a common trunk with the vesical arteries (arrowhead) from the anterior division of the left internal iliac artery; the left obturator artery was not identified. CO₂ DSA allowed concomitant opacification of the ipsilateral external iliac artery, which exhibited an aberrant extra pelvic obturator artery (thick black arrow), arising from a common trunk with the inferior epigastric artery (unfilled arrow); (B) The left prostatic artery was tortuous (thin black arrow) giving intra-glandular branches to the left prostatic lobe (asterisks); the left internal pudendal (thick black arrow) artery had a normal intra-pelvic course. CO_2, carbon dioxide; DSA, digitally subtracted angiography.

Contrast enhanced visualization of left prostatic artery. Contrast enhanced cone beam CT in a coronal oblique view demonstrates intense blush of the left prostate median lobe (asterisks). CT, computed tomography.

CO₂ DSA visualization of right internal iliac and prostatic arteries. (A) CO₂ DSA of the right internal iliac artery in a 45-degree ipsilateral oblique perfectly delineated the pelvic vasculature. The right prostate artery (thin black arrows) was unambiguously identified arising from a common trunk with the vesical arteries (thick black arrow) branching from the anterior division of the right internal iliac artery. CO₂ opacified the intra-glandular helical prostatic arterial branches (black arrowheads); (B) Contrast cone beam CT showed right hemi-prostate blush (asterisks), with visualization of the intra-glandular helical arterial branches (arrowheads). CO_2, carbon dioxide; DSA, digitally subtracted angiography; CT, computed tomography.

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