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Treatment of a patient with post-TURP hemorrhage using bilateral SAPE

Nature Reviews Urology volume 6, pages 680–685 (2009)Cite this article

Abstract

Background. A 74-year-old man developed severe, life-threatening bleeding refractory to endoscopic fulguration from a prostatic capsular perforation while undergoing transurethral resection of prostate (TURP) for complicated benign prostatic hyperplasia. At the time of the procedure the patient had several comorbidities, including hypertension and associated nephropathy, and erectile dysfunction.

Investigations. CT angiography and pelvic arteriography.

Diagnosis. Post-TURP arterial hemorrhage refractory to conventional methods of hemostasis, complicated by TURP syndrome and disseminated intravascular coagulopathy.

Management. Bilateral selective arterial prostatic embolization, after endoscopic hemostasis and continuous catheter balloon traction failed to stop the hemorrhage.

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Figure 1: CT of the case patient.
Figure 2: Left iliac angiography.
Figure 3: Right internal iliac angiography before and after gel foam embolization.
Figure 4: The pelvic arteries.

References

  1. Mebust, K. & Holtgrewe, H. L. Current status of transurethral prostatectomy. A review of the AUA National Cooperative Study. World J. Urol. 6, 194–197 (1989).

    Article  Google Scholar 

  2. Reich, O. et al. Morbidity, mortality and early outcome of transurethral resection of the prostate: a prospective multicenter evaluation of 10,654 patients. J. Urol. 180, 246–249 (2008).

    Article  PubMed  Google Scholar 

  3. Pereria, S. J. et al. Dynamic helical computed tomography scan accurately detects hemorrhage in patients with pelvic fracture. Surgery 128, 678–685 (2000).

    Article  Google Scholar 

  4. Gravenstein, D. Transurethral resection of the prostate (TURP) syndrome: a review of the pathophysiology and management. Anesth. Analg. 84, 438–446 (1997).

    Article  CAS  PubMed  Google Scholar 

  5. Hahn, R. G. Fluid absorption in endoscopic surgery. Br. J. Anaesth. 96, 8–20 (2006).

    Article  CAS  PubMed  Google Scholar 

  6. Gross, P., Reimann, D., Henschkowski, J. & Damian, M. Treatment of severe hyponatremia: conventional and novel aspects. J. Am. Soc. Nephrol. 12, S10–S14 (2001).

    CAS  PubMed  Google Scholar 

  7. Crowley, K., Clarkson, K., Hannon, V., McShane, A. & Kelly, D. G. Diuretics after transurethral prostatectomy: a double-blind controlled trial comparing frusemide and mannitol. Br. J. Anaesth. 65, 337–341 (1990).

    Article  CAS  PubMed  Google Scholar 

  8. Rassweiler, J., Teber, D., Kuntz, R. & Hofmann, R. Complications of transurethral resection of the prostate (TURP)—incidence, management, and prevention. Eur. Urol. 50, 969–979 (2006).

    Article  PubMed  Google Scholar 

  9. Vassiliu, P., Sava, J., Toutouzas, K. G. & Velmahos, G. C. Is contrast as bad as we think? Renal function after angiographic embolization of injured patients. J. Am. Coll. Surg. 194, 142–146 (2002).

    Article  PubMed  Google Scholar 

  10. Rastinehad, A. R. et al. Selective arterial prostatic embolization (SAPE) for refractory hematuria of prostatic origin. Urology 71, 181–184 (2008).

    Article  PubMed  Google Scholar 

  11. Lang, E. K. Transcatheter embolization of pelvic vessels for control of intractable hemorrhage. Radiology 140, 331–339 (1981).

    Article  CAS  PubMed  Google Scholar 

  12. Michel, F. et al. Arterial embolization for massive hematuria following transurethral prostatectomy. J. Urol. 168, 2550–2551 (2002).

    Article  PubMed  Google Scholar 

  13. Park, Y. H., Lee, J. H. & Kim, H. H. Severe bleeding after laparoscopic radical prostatectomy: successful management with transarterial embolization. J. Endourol. 22, 2687–2689 (2008).

    Article  PubMed  Google Scholar 

  14. Ibarra, R., Magee, C., Ferral, H. & Thompson, I. M. Post-prostatectomy bleeding managed by endovascular embolization. J. Urol. 169, 276–277 (2003).

    Article  PubMed  Google Scholar 

  15. Seavers, R., Lynch, J., Ballard, R., Jernigan, S. & Johnson, J. Hypogastric artery ligation for uncontrollable hemorrhage in acute pelvic trauma. Surgery 55, 516–519 (1964).

    CAS  PubMed  Google Scholar 

  16. Nabi, G., Sheikh, N., Greene, D. & Marsh, R. Therapeutic transcatheter arterial embolization in the management of intractable haemorrhage from pelvic urological malignancies: preliminary experience and long-term follow-up. BJU Int. 92, 245–247 (2003).

    Article  CAS  PubMed  Google Scholar 

  17. Sadahiro, S. et al. Vesicular blood flow after ligation of the internal iliac arteries in low anterior resection or abdominoperineal resection. Dis. Colon Rectum 42, 1475–1479 (1999).

    Article  CAS  PubMed  Google Scholar 

  18. Andriole, G. L. & Sugarbaker, P. H. Perineal and bladder necrosis following bilateral internal iliac artery ligation report of a case. Dis. Colon Rectum 28, 183–184 (1985).

    Article  CAS  PubMed  Google Scholar 

  19. Cynamon, J. et al. Hypogastric artery coil embolization prior to endoluminal repair of aneurysms and fistulas: Buttock claudication, a recognized but possibly preventable complication. J. Vasc. Interv. Radiol. 11, 573–577 (2000).

    Article  CAS  PubMed  Google Scholar 

  20. Shin, R. K., Stecker, M. M. & Imbesi, S. G. Peripheral nerve ischaemia after internal iliac artery ligation. J. Neurol. Neurosurg. Psychiatry 70, 411–412 (2001).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Levi, M., Toh, C. H., Thachil, J. & Watson, H. G. Guidelines for the diagnosis and management of disseminated intravascular coagulation. British Committee for Standards in Haematology. Br. J. Haematol. 145, 24–33 (2009).

    Article  CAS  PubMed  Google Scholar 

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Acknowledgements

We would like to thank Dr. Pearlie Tan for her illustration of the anatomy of the internal iliac arteries (Figure 4).

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Authors and Affiliations

  1. Department of Urology, National University Health System, Singapore

    Lincoln Tan, David Consigliere & Chin Tiong Heng

  2. Department of Diagnostic Radiology, National University Health System, Singapore

    Sudhakar K. Venkatesh

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  1. Lincoln Tan
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Correspondence to Lincoln Tan.

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The authors declare no competing financial interests.

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Tan, L., Venkatesh, S., Consigliere, D. et al. Treatment of a patient with post-TURP hemorrhage using bilateral SAPE. Nat Rev Urol 6, 680–685 (2009). https://doi.org/10.1038/nrurol.2009.215

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