Post-prostatectomy Bleeding Managed by Endovascular Embolization

Abstract

Prostate cancer is the second most common cause of cancer related mortality in males in the United States. Radical prostatectomy is a common treatment for localized prostate cancer. Significant post-prostatectomy hemorrhage is a rare but serious complication, occurring in less than 0.5% of cases.1 Treatment options include surgical exploration with ligation of bleeding sites, observation with ultimate tamponade and endovascular control. Intraoperative internal iliac artery ligation has previously been recommended to decrease blood loss.2 However, postoperative endovascular control is another option.3 We report the results of this approach in a patient with postoperative bleeding from the artery to the seminal vesicle. CASE REPORT A 70-year-old man with Gleason score 4 3, prostate specific antigen 4.7 ng./ml., T2a prostate cancer underwent uneventful nerve sparing radical retropubic prostatectomy and pelvic lymphadenectomy. Estimated blood loss was 900 cc. The following morning the patient complained of pelvic pain, and hemoglobin and hematocrit were 7.4 gm./dl. (normal 13.5 to 17.5) and 21.5% (normal 41% to 53%), respectively. There was minimal output from the pelvic drain. Two units of blood were transfused, and computerized tomography of the abdomen and pelvis demonstrated a large