Selective and super-selective angioembolisation for intractable haematuria of prostatic origin

Abstract

Objective: To assess the role and outcomes following selective and super-selective angioembolisation in the management of patients with intractable haematuria of prostatic origin.

Materials and methods: A retrospective analysis of data from 10 patients undergoing selective and super-selective angioembolisation for intractable haematuria of prostatic origin at our institution between January 2017 and January 2020. There were six patients of advanced carcinoma prostate, two patients of benign prostatic hyperplasia (with significant comorbidities) and two patients with bleeding following trans-urethral resection of the prostate. After initial stabilisation, the patients were subjected to selective and super-selective angioembolisation of bleeding vessels using the standard technique and mixture of PVA particles and Gel foam slurry as the embolising agent.

Results: Mean age of patients in the study was 73.9 years (range 65–82 years, SD ± 5.17). Eight patients had associated comorbidities. Mean haemoglobin and haematocrit values pre-procedure were 7.64 gm/dl and 28.7% respectively and post-procedure were 7.24 gm/dl and 27.4% respectively. The difference between these values was statistically insignificant (p-value 0.30 for haemoglobin and 0.44 for haematocrit). Two patients needed post-procedure blood transfusions. Mean follow-up was 16.3 months. No patient had immediate rebleeding (initial six months), but two patients with advanced carcinoma prostate had late rebleeding needing repeat nonselective embolisation. Complications were minor (Clavien Dindo Class I/II). Mean hospital stay was 5.7 days (range 4–7 days, SD ± 0.82).

Conclusion: Selective and super-selective angioembolisation can be employed safely and effectively in the management of intractable haematuria of prostatic origin with good short to midterm results.