title: Minimally invasive management of postoperative bleeding after radical prostatectomy: transarterial embolization.
abstract: OBJECTIVE
  Severe postoperative bleeding after radical prostatectomy is a rare, but serious, complication. Massive postoperative bleeding causing hemodynamic instability necessitates open surgical exploration and can be associated with considerable morbidity. We report our experience with minimally invasive management of postprostatectomy hemorrhage via transarterial embolization (TAE).
  
  
  METHODS
  From July 2006 to April 2009, men with severe immediate postoperative bleeding that caused hemodynamic instability after radical prostatectomy were enrolled. We performed emergency angiography and superselective TAE instead of surgical exploration as the initial management. TAE was performed using an enbucrilate:ethiodized poppy seed oil 1:3 mixture. We determined treatment success rate, efficacy, and safety.
  
  
  RESULTS
  A total of 4 among 563 (0.7%) patients had postoperative bleeding that fit the inclusion criteria in this period. CT angiography revealed active bleeding in all cases. All patients were successfully treated with TAE without any additional treatment, such as surgical exploration, and there was no treatment-related adverse event. Three (75%) patients regained continence within 6 months. Two (50%) patients were potent at 12-month follow-up.
  
  
  CONCLUSIONS
  During a 3-year period, we successfully treated all patients who had severe immediate postoperative bleeding after radical prostatectomy with TAE. We concluded that rapid diagnosis by CT angiography and early TAE could replace surgical exploration in this situation. In addition, this could minimize the morbidity associated with severe bleeding, transfusion, and open surgical exploration.
authors.affiliation: Department of Urology, Seoul National University Hospital, Seoul, Korea.
authors.forename: Chang Wook
authors.initials: CW
authors.lastname: Jeong
authors.forename: Yong Hyun
authors.initials: YH
authors.lastname: Park
authors.forename: Ja Hyeon
authors.initials: JH
authors.lastname: Ku
authors.forename: Cheol
authors.initials: C
authors.lastname: Kwak
authors.forename: Hyeon Hoe
authors.initials: HH
authors.lastname: Kim
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography; D001158:Arteries; D004621:Embolization, Therapeutic / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D019106:Postoperative Hemorrhage / Q000000981:diagnostic imaging / Q000209:etiology* / Q000473:pathology / Q000628:therapy*; D011467:Prostate / Q000098:blood supply* / Q000000981:diagnostic imaging / Q000601:surgery; D011468:Prostatectomy / Q000009:adverse effects*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome