title: Prostate Artery Embolization (PAE) in the Management of Refractory Hematuria of Prostatic Origin Secondary to Iatrogenic Urological Trauma: A Safe and Effective Technique.
abstract: BACKGROUND
  Incidence of refractory hematuria of prostatic origin (RHPO) is extremely rare, with an iatrogenic etiology even rarer. When conservative methods fail to control bleeding, more invasive surgical methods are needed. In this article we describe our experience with prostatic artery embolization (PAE) as a minimally invasive alternative treatment option in patients with RHPO secondary to iatrogenic urologic trauma.
  
  
  METHODS
  Three patients presented with RHPO. The etiologies were transurethral resection of prostate surgery, Foley catheter removal with a supratherapeutic international normalized ratio and self-traumatic Foley catheter removal respectively. Stepwise management with conservative and medical methods failed to control bleeding. Under local anesthesia and moderate sedation, bilateral PAE was performed via a right common femoral artery access and using cone beam computed tomography. An embolic mixture containing 300-500 um Embosphere® Microspheres (Biosphere Medical, Rockland, MA) was injected under fluoroscopic guidance until stasis was achieved. PAE using the described technique was a technical and clinical success in all three patients. Hematuria resolved within a period of 24 hours. There were no intra- or periprocedural complications.
  
  
  CONCLUSIONS
  PAE offers a reasonable option in treatment of RHPO, regardless of the cause and may be attempted prior to surgical techniques or sometimes in conjunction. Being minimally invasive and performed under local anesthesia, PAE is especially useful when excessive bleeding prevents adequate visualization of a bleeding source during cystoscopy and in the elderly age group with several comorbidities. An added advantage is the prostatic parenchymal ischemia leading to significant prostate volume reduction and alleviation of the obstructive symptoms.
authors.affiliation: Department of Interventional Radiology, Jackson Memorial Hospital/University of Miami Hospital, Miami, FL.
authors.forename: Isaam
authors.initials: I
authors.lastname: Kably
authors.affiliation: Department of Interventional Radiology, Jackson Memorial Hospital/University of Miami Hospital, Miami, FL. Electronic address: keithjppereira@gmail.com.
authors.forename: Keith
authors.initials: K
authors.lastname: Pereira
authors.affiliation: Department of Urology, Jackson Memorial Hospital/University of Miami Hospital, Miami, FL.
authors.forename: William
authors.initials: W
authors.lastname: Chong
authors.affiliation: Department of Interventional Radiology, Jackson Memorial Hospital/University of Miami Hospital, Miami, FL.
authors.forename: Shivank
authors.initials: S
authors.lastname: Bhatia
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001158:Arteries; D004621:Embolization, Therapeutic; D006417:Hematuria / Q000209:etiology / Q000628:therapy*; D006801:Humans; D007049:Iatrogenic Disease; D008297:Male; D008875:Middle Aged; D011467:Prostate / Q000098:blood supply*; D020728:Transurethral Resection of Prostate / Q000009:adverse effects; D014546:Urinary Catheterization / Q000009:adverse effects