Transarterial embolization for pelvic hematoma following laparoscopic radical prostatectomy: A case report and review of the literature

Unexpected encapsulated hematoma after Rezum therapy: First outcome of an emerging therapy

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.

Contemporary Management of Hemorrhage After Minimally Invasive Radical Prostatectomy

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.

Bleeding after prostatectomy: endovascular management

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.

Unexpected hemorrhage of a rare vessel, a pubic branch of the external iliac artery, after laparoscopic radical prostatectomy: Case report

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.