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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.

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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

Authors
  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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