Selective arterial prostatic embolization (SAPE) for refractory hematuria of prostatic origin.
OBJECTIVE
To assess SAPE as an alternative treatment option in patients with refractory hematuria of prostatic origin.


METHODS
A retrospective analysis of charts from 10 patients. Two patients were excluded from the analysis because of severe atherosclerotic disease that prevented selective angiography of the pelvic vasculature. Therefore, 8 patients, mean age of 78.3 +/- 7.1 years with a history of refractory hematuria of prostatic origin were analyzed. All patients failed conventional therapy. The selective embolization procedures were performed between 2000 and 2006. Success was monitored with postembolization angiography and cessation of hematuria clinically.


RESULTS
Of the 8 patients, 6 had a history of adenocarcinoma of the prostate (mean Gleason Grade 7, range 5 to 9); 4 were previously treated with external beam radiation. The remaining patient's histories were consistent with benign prostatic hypertrophy. SAPE was technically successful in all 8 patients and resulted in immediate cessation of gross hematuria. Mean follow-up postembolization was 20.0 months (range 1.5 to 86.3 months). One patient had gross hematuria develop 14 months after embolization that was attributed to a bladder tumor recurrence. One patient with T4 prostate cancer had a rectovesical fistula develop 1 month after embolization.


CONCLUSIONS
SAPE results in cessation of refractory gross hematuria in patients with benign prostate hyperplasia and patients with prostate cancer previously treated with radiotherapy. SAPE may be considered an effective treatment for gross hematuria in patients with refractory hematuria regardless of the cause (radiation, cancer and/or hyperplasia).
Rastinehad
Ardeshir R
AR
The Arthur Smith Institute for Urology, North Shore Long Island Jewish Health System, New Hyde Park, New York 11040, USA. nycurology@gmail.com
Caplin
Drew M
DM
Ost
Michael C
MC
VanderBrink
Brian A
BA
Lobko
Igor
I
Badlani
Gopal H
GH
Weiss
Gary H
GH
Kavoussi
Louis R
LR
Siegel
David N
DN
D000230:Adenocarcinoma / Q000150:complications*; D000368:Aged; D001158:Arteries; D004621:Embolization, Therapeutic / Q000379:methods*; D006417:Hematuria / Q000209:etiology / Q000628:therapy*; D006801:Humans; D008297:Male; D011467:Prostate / Q000098:blood supply*; D011470:Prostatic Hyperplasia / Q000150:complications*; D011471:Prostatic Neoplasms / Q000150:complications*; D012189:Retrospective Studies