RESUMEN
BACKGROUND: Prostate artery embolization (PAE) is a relatively safe and effective alternative method for the treatment of lower urinary tract symptoms secondary to benign prostatic hyperplasia. The adverse events caused by PAE are primarily mild, including urinary tract infection, acute urinary retention, dysuria, fever, etc. Severe complications, such as nontarget organ embolism syndrome or penile glans ischemic necrosis, are rare. Here, we report a case of severe ischemic necrosis of the glans penis after PAE and review the literature. CASE PRESENTATION: An 86-year-old male patient was admitted to the hospital due to progressive dysuria with gross hematuria. The patient underwent placement of a three-way urinary catheter to facilitate continuous bladder flushing, hemostasis, and rehydration. After admission, his hemoglobin decreased to 89 g/L. After an examination, the diagnosis was benign prostatic hyperplasia with bleeding. During communication with the patient regarding treatment, he requested prostate artery embolization due to his advanced age and concomitant disease status. He underwent bilateral prostate artery embolization under local anesthesia. His urine gradually turned clear. However, on the 6th day after embolization, the glans gradually showed ischemic changes. On the 10th day, there was partial necrosis and blackening of the glans. The glans completely healed, and the patient was able to urinate smoothly on the 60th day after local cleaning and debridement, the administration of pain relief, anti-inflammatory and anti-infection agents, and external application of burn ointment. CONCLUSION: Penile glans ischemic necrosis after PAE is rare. The symptoms include pain, congestion, swelling, and cyanosis in the glans.
Asunto(s)
Próstata , Hiperplasia Prostática , Masculino , Humanos , Anciano de 80 o más Años , Disuria , Arterias , NecrosisRESUMEN
OBJECTIVE: To observe the clinical effect of prostatic artery embolization (PAE) in the treatment of high-risk patients with BPH. METHODS: Nine high-risk patients with BPH underwent PAE in the Third Affiliated Hospital of Anhui Medical University from January 2016 to June 2018. We followed up the patients and obtained their IPSS, quality of life score (QOL), postvoid residual urine volume (PVR), maximum urinary flow rate (Qmax), prostate volume (PV), hours of undisturbed sleep (HUS), Self-Rating Anxiety Scale score (SAS) and incidence of postoperative complications before and at 6, 12 and 24 months or longer after surgery, followed by comparative analysis of the parameters. RESULTS: Compared with baseline, IPSS, QOL, PVR, Qmax, PV, HUS and SAS were all significantly improved in the patients at 6, 12 and ≥24 months after PAE (P < 0.05). Only 1 case complained of mild numbness in the buttocks, which was gradually relieved after acupuncture therapy. CONCLUSIONS: Prostatic artery embolization is definitely effective for the treatment of high-risk patients with BPH with the bladder volume ≥200 ml, with few postoperative complications, and can be used as an effective therapeutic supplementary for improving the urination symptoms of the patients.