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Unexpected encapsulated hematoma after Rezum therapy: First outcome of an emerging therapy. Urol Case Rep 2022; 44:102125. [PMID: 35707222 PMCID: PMC9188957 DOI: 10.1016/j.eucr.2022.102125] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Revised: 05/29/2022] [Accepted: 06/03/2022] [Indexed: 11/24/2022] Open
Abstract
Rezum therapy is in emerging minimally invasive treatment for BPH. Complications of Rezum are underreported in the literature. We report a case of a 61-year-old male patient who presented to ED two months after Rezum with hematuria and clot retention. US showed prostate size of 315 g with cystic changes. The patient was managed with TURP and unexpectedly showed big contained hematoma below the bladder neck which was evacuated with adequate hemostasis.
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Dean LW, Tin AL, Chesnut GT, Assel M, LaDuke E, Fromkin J, Vargas HA, Ehdaie B, Coleman JA, Touijer K, Eastham JA, Laudone VP. Contemporary Management of Hemorrhage After Minimally Invasive Radical Prostatectomy. Urology 2019; 130:120-125. [PMID: 31034916 DOI: 10.1016/j.urology.2019.04.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 04/12/2019] [Accepted: 04/17/2019] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To describe contemporary management and outcomes of patients experiencing postoperative hemorrhage after minimally invasive radical prostatectomy. MATERIALS AND METHODS We retrospectively analyzed data from patients who underwent minimally invasive radical prostatectomy at our institution between January 2010 and January 2017. Clinically significant hemorrhage was defined as a decrease in hemoglobin of ≥30% or 4 g/dL from preoperative to 4 or 14 hours postoperative measurement, receiving a blood transfusion within 30 days, or undergoing a secondary procedure to control bleeding. Patients were analyzed in 3 groups: (1) serially monitored only, (2) received a blood transfusion, and (3) underwent a secondary procedure. Outcomes included imaging studies performed, length of stay, emergency room visits, hospital readmissions, complication rates, and functional outcomes. RESULTS Of 3749 men, 4% (151/3749) had clinically significant hemorrhage, 1.6% (60/3749) received a transfusion; 0.32% (12/3749) underwent a secondary procedure to control bleeding. In a 30-day composite outcome, increased healthcare utilization (emergency room visit, readmission, or Grade ≥3 complications), was seen in 25% of the serial monitoring group, 65% of the transfusion group, and 100% in the secondary procedure group. This rate in 3598 men without hemorrhage was 12.5%. One-year erectile function was poorest in men who underwent a secondary procedure. Urinary functional outcomes were similar in the 3 groups. CONCLUSION Most patients experiencing clinically significant hemorrhage will stabilize without transfusion, and a very small fraction require secondary intervention. Patients experiencing milder bleeding events utilized additional healthcare resources at approximately twice the rate of those who did not, warranting appropriate counseling and postoperative monitoring.
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Affiliation(s)
- Lucas W Dean
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Amy L Tin
- Department of Epidemiology-Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Gregory T Chesnut
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.
| | - Melissa Assel
- Department of Epidemiology-Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Emily LaDuke
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Jillian Fromkin
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Behfar Ehdaie
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Jonathan A Coleman
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Karim Touijer
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - James A Eastham
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Vincent P Laudone
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
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Ierardi AM, Jannone ML, Brambillasca PM, Zannoni S, Damiani G, Rossi UG, Granata AM, Petrillo M, Carrafiello G. Bleeding after prostatectomy: endovascular management. Gland Surg 2019; 8:108-114. [PMID: 31183320 DOI: 10.21037/gs.2019.02.03] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Background To evaluate role of interventional radiology (IR) in post-surgical haemorrhagic complications of prostatectomy. Methods A retrospective study was performed. From April 2015 to January 2018, 10 patients referred to IR Department for haemorrhagic complications post radical prostatectomy (RP). All patients (mean age: 68.5 years; range, 58-85 years) were successfully treated with superselective trans-arterial embolization. We evaluated technical and clinical success and post procedural complications. Results Technical and clinical success was 100% (10/10) and no major complications were identified. No complications related to the endovascular procedures occurred. No recurrences during follow-up (8-20 months) were observed. Among minor complications, only 20% (2/10) developed mild post embolization syndrome. Conclusions The endovascular management of significant haemorrhage after prostatectomy is safe and long-term effective, with no major ischaemic events associated to embolization.
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Affiliation(s)
- Anna Maria Ierardi
- Diagnostic and Interventional Radiology Department, San Paolo Hospital, University of Milan, Milan, Italy
| | - Maria Laura Jannone
- Diagnostic and Interventional Radiology Department, San Paolo Hospital, University of Milan, Milan, Italy
| | - Pietro Maria Brambillasca
- Diagnostic and Interventional Radiology Department, San Paolo Hospital, University of Milan, Milan, Italy
| | - Stefania Zannoni
- Diagnostic and Interventional Radiology Department, San Paolo Hospital, University of Milan, Milan, Italy
| | | | - Umberto G Rossi
- Department of Diagnostic Imaging, Interventional Radiology Unit, E.O. Galliera Hospital, Genova, Italy
| | | | - Mario Petrillo
- Diagnostic and Interventional Radiology Department, San Paolo Hospital, University of Milan, Milan, Italy
| | - Gianpaolo Carrafiello
- Diagnostic and Interventional Radiology Department, San Paolo Hospital, University of Milan, Milan, Italy
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Jiang WX, Zhou ZE, Yan WG, Pan J, Ji ZG. Unexpected hemorrhage of a rare vessel, a pubic branch of the external iliac artery, after laparoscopic radical prostatectomy: Case report. Medicine (Baltimore) 2017; 96:e9357. [PMID: 29390411 PMCID: PMC5815823 DOI: 10.1097/md.0000000000009357] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
RATIONALE Postoperative hemorrhage is a rare complication after laparoscopic radical prostatectomy (LRP), with no case reports of bleeding from the external iliac artery in the literature. PATIENT CONCERNS A 73-year-old man diagnosed with clinical stage 2c prostate cancer underwent LRP successfully with only approximately 200 mL of intraoperative blood loss. However, his blood pressure dropped from 135/74 to 80/49 mm Hg and his hemoglobin decreased by 66 g/L compared with the preoperative level within 5 hours. DIAGNOSES Active hemorrhage from a pubic branch of the external iliac artery was found by digital subtraction angiography (DSA). INTERVENTIONS The patient was treated with superselective intraarterial embolization. OUTCOMES The bleeding stopped and the patient recovered uneventfully with no further hemorrhage or other complications. LESSONS Although postoperative hemorrhage after LRP is exceptionally rare, it can occur not only in the internal iliac artery but also in the external iliac artery. In addition, contracted pelvis cases should be addressed with more caution by the laparoscope holder in case external iliac artery is injured.
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Affiliation(s)
| | | | | | - Jie Pan
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, P.R. China
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Bonne L, Gillardin P, De Wever L, Vanhoutte E, Joniau S, Oyen R, Maleux G. Endovascular Management of Severe Arterial Haemorrhage After Radical Prostatectomy: A Case Series. Cardiovasc Intervent Radiol 2017; 40:1698-1705. [DOI: 10.1007/s00270-017-1715-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Accepted: 05/23/2017] [Indexed: 10/19/2022]
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