Abstract No. 452 Prostatic artery embolization for inpatient and emergent hematuria: a single-system experience

Abstract

Prostatic artery embolization (PAE) is typically an elective outpatient procedure performed for lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH). However, PAE is also performed for hematuria, including in inpatient or emergent settings. This report aims to elucidate the causes of hematuria in this population. PAE cases from June 2014 until August 2020 at two hospitals in a tertiary academic health system were queried (n = 216). Patients were included in this study if they underwent inpatient or emergent PAE for hematuria as the primary indication. For all consecutive patients meeting these inclusion criteria, demographic, baseline, procedural, and follow-up data were collected. Of the 216 patients queried, 10 (4.6%) received PAE with hematuria as the primary indication. The patients studied had a mean age of 73.0 years (SD = 11.1). No patients reported any other urinary symptoms (frequency, urgency, straining, incomplete emptying, nocturia, etc). Seven of the 10 patients’ procedures were a technical success defined as stasis. Of these 10 patients, 6 had bleeding secondary to prior transurethral resection of the prostate (TURP). Of those post-TURP patients, 3 were performed acutely for hematuria (3, 6, and 11 days) and 3 for chronic hematuria (2 months, 12 months, and 14 months). Of these 6 patients, 3 were never documented as re-presenting with hematuria. Two presented to the emergency department within 30 days for recurrent gross hematuria, and one reported chronic hematuria for one month following discharge. Two other patients presented with hematuria secondary to other procedures, robotic prostatectomy and TURBT. One was due to hemorrhage of the prostate secondary to metastatic adenocarcinoma of the prostate presenting with hypotension and anemia. One patient presented with hematuria secondary to invasive large B-cell lymphoma and treatment with heparin. In this patient, the right prostatic artery could not be visualized and so bilateral PAE could not be achieved. Preliminary single system experience showed that post-TURP hematuria was the most common cause of reason for pursuing emergent PAE. More research is needed to determine the prevalence of recurrence of hematuria in these patients.