Angioembolization for massive pelvic hematoma after prostatic urethral lift

Abstract

Introduction Pelvic hematomas are a rare complication of prostatic urethral lift. We would like to report the first case of massive pelvic hematoma after prostatic urethral lift that was successfully managed by selective angioembolization. Case presentation An 83‐year‐old gentleman with benign prostatic hyperplasia underwent prostatic urethral lift. Although the procedure was uneventful, he developed shock while in the recovery room. Urgent contrast computed tomography scan showed a large heterogenous hematoma at the right pelvis extending to the right retroperitoneum with contrast extravasation noted. Urgent angiogram confirmed extravasation from the right prostatic artery. Angioembolization with coils and 33% N‐butyl cyanoacrylate glue was successfully performed. Conclusion Prostatic urethral lift can be complicated by the rare massive pelvic hematoma, possibly more common in small prostates. With a prompt contrast computed tomography scan, pelvic hematomas can be managed with angioembolization first and hopefully prevent open exploratory surgery.

Two cases of pelvic hematoma after prostatic urethral lift surgery

“…12 To the best of our knowledge, only six cases of the occurrence and management of pelvic hematoma after PUL have been reported, as shown in Table 1 together with our cases. 5 , 6 , 7 , 8 , 9 , 10 In these case reports, age (66–83 years old), PV (14–45 mL), and the number of implants (2–5) seemed to be not associated with the occurrence of pelvic hematomas, suggesting that compression of the prostate using UroLift® and patient position during surgery are the main rick factors for the occurrence of pelvic hematoma after PUL.…”

“… 3 , 4 The most frequently reported complications of PUL are spontaneously resolving dysuria and hematuria; however, the occurrence of major complications, such as pelvic hematoma, has rarely been reported. 5 , 6 , 7 , 8 , 9 , 10 We describe two Japanese cases of pelvic hematoma after PUL. These patients underwent conservative treatment or hematoma removal.…”