Case report of avascular necrosis of the glans penis after PAE embolization

Abstract

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.

Ischemic penile necrosis following embolization of the prostate for benign prostatic hyperplasia: A case report

“…The clinical presentation is primarily characterised by intense recurrent pain in the penis, accompanied by a worsening of urinary symptoms, manifested by pronounced dysuria, with a probability of progressing to acute urinary retention. 9 In the reported case, the patient exhibited intense perineal pain associated with the progressive onset of complete urinary retention, necessitating catheterisation of the bladder. This deterioration in lower urinary tract symptoms (LUTS) could be attributed to bladder damage associated with microparticle migration, as well as detrusor hyperactivity.…”

“…The management strategy seems to focus on local treatments, which include analgesics, anti-inflammatories, fusidic acid or potassium permanganate applied with moist saline compresses. 1 , 7 , 9 Consideration of antibiotic therapy with ciprofloxacin at a dose of 1g per day may also be recommended. 11 Furthermore, daily intake of 100 mg Aspirin has shown significant benefits in improving vasculogenic erectile dysfunction.…”