|
|
Intractable hematuria due to giant prostatic hyperplasia effectively treated with prostatic artery embolization |
Issam Kablya,b,Alexander Bodea,*()
|
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 |
|
|
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.
|
Received: 01 March 2018
Available online: 20 July 2020
|
Corresponding Authors:
Alexander Bode
E-mail: adb127@med.miami.edu
|
|
|
|
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. CO2, 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). CO2, carbon dioxide; DSA, digitally subtracted angiography; CT, computed tomography.
|
[1] |
Maliakal J, Mousa EE, Menon V. Giant prostatic hyperplasia: fourth largest prostate reported in medical literature. Sultan Qaboos Univ Med J 2014; 14:e253-6.
|
[2] |
Bhatia S, Kava B, Pereira K, Kably I, Harward S, Narayanan G. Prostate artery embolization for giant prostatic hyperplasia. J Vasc Interv Radiol 2015; 26:1583-5.
|
[3] |
Thorpe A, Neal D. Benign prostatic hyperplasia. Lancet 2003; 361:1359-67.
|
[4] |
Fishman JR, Merrill DC. A case of giant prostatic hyperplasia. Urology 1993; 42:336-7.
|
[5] |
Rodriguez E, Skarecky D, Narula N, Ahlering TE. Prostate volume estimation using the ellipsoid formula consistently underestimates actual gland size. J Urol 2008; 179:501-3.
|
[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 2016; 88:218-21.
|
[7] |
Gleeson TG, Bulugahapitiya S. Contrast-induced nephropathy. AJR Am J Roentgenol 2004; 183:1673-89.
|
[8] |
Hawkins JrJr, Wilcox CS, Kerns SR, Sabatelli FW. CO2 digital angiography: a safer contrast agent for renal vascular imaging? Am J Kidney Dis 1994; 24:685-94.
|
[9] |
de Assis AM, Moreira AM, de Paula Rodrigues VC, Yoshinaga EM, Antunes AA, Harward SH, et al. Prostatic artery embolization for treatment of benign prostatic hyperplasia in patients with prostates > 90 g: a prospective single-center study. J Vasc Interv Radiol 2015; 26:87-93.
|
[1] |
Guangju Ge,Zhenghui Wang,Mingchao Wang,Gonghui Li,Zuhao Xu,Yukun Wang,Shawpong Wan. Inadvertent insertion of nephrostomy tube into the renal vein following percutaneous nephrolithotomy: A case report and literature review[J]. Asian Journal of Urology, 2020, 7(1): 64-67. |
[2] |
Ahmed Saadi, Abderrazak Bouzouita, Mohamed Hedi Rebai, Mohamed Cherif, Walid Kerkeni, Haroun Ayed, Amine Derouiche, Hatem Rajhi, Riadh Ben Slama, Najla Mnif, Mohamed Chebil. Superselective embolisation of bilateral superior vesical arteries for management of intractable hematuria in context of metastatic bladder cancer[J]. Asian Journal of Urology, 2017, 4(2): 131-134. |
[3] |
Ricardo Palmerola, Vinay Patel, Christopher Hartman, Chris Sung, David Hoenig, Arthur D. Smith, Zeph Okeke. Renal functional outcomes are not adversely affected by selective angioembolization following percutaneous nephrolithotomy[J]. Asian Journal of Urology, 2017, 4(1): 27-30. |
|
|
|
|