Clinical case: bladder necrosis after prostate embolization in a patient with prostatic hyperplasia

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Abstract

This article describes a clinical case of bladder necrosis developed after X-ray endovascular embolization of prostatic arteries of a 62-year-old patient with a verified diagnosis of BPH (benign prostatic hyperplasia). The complication resulted in the necessity of urgent surgical intervention, namely, laparotomy, cystprostatectomy and bilateral percutaneous nephrostomy. In the early postoperative period the patient had intense cutting pain in the left side of the abdomen. Examination revealed the inflow of small intestinal contents through the pelvic drainage, which was the reason for relaparotomy, abdominal cavity revision, uturing the small intestine perforation, suturing the small intestine pre-perforation, sanation and drainage of the abdominal cavity in an emergency procedure. The patient was discharged in a satisfactory condition under the supervision of a urologist by m/w on the 36th day after endovascular embolization of prostatic arteries. The eight months after discharge, the patient underwent a successful Bricker’s operation on creating an alternative urinary diversion route at the First Sechenov Moscow State Medical University of the Russian Federation.

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About the authors

A. A. Podoynicin

MONIKI

Author for correspondence.
Email: a4955145801@gmail.com

д.м.н., руководитель отделения урологии

Russian Federation, Moscow

E. A. Mamedov

MONIKI

Email: elvin_mammadli@mail.ru

к.м.н., заведующий отделением урологии

Russian Federation, Moscow

N. А. Amosov

MONIKI

Email: Nikita_amosov@mail.ru

к.м.н., старший научный сотрудник отделения урологии

Russian Federation, Moscow

S. V. Garmash

MONIKI

Email: 89262343904@mail.ru

к.м.н., заведующий отделением онкоурологии

Russian Federation, Moscow

D. A. Kuznecova

MONIKI

Email: dasha_kuzn96@mail.ru

аспирант кафедры урологии

Russian Federation, Moscow

E. V. Shpot

First Moscow State Medical University named after I.M. Sechenov

Email: dasha_kuzn96@mail.ru

д.м.н., профессор, заведующий онкоурологическим отделением Института урологии и репродуктивного здоровья человека

Russian Federation, Moscow

G. A. Mashin

First Moscow State Medical University named after I.M. Sechenov

Email: dasha_kuzn96@mail.ru

к.м.н., врач онкоурологического отделения Института урологии и репродуктивного здоровья человека

Russian Federation, Moscow

P. Sh. Maltsagova

First Moscow State Medical University named after I.M. Sechenov

Email: dasha_kuzn96@mail.ru

студентка 6 курса лечебного факультета

Russian Federation, Moscow

References

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  2. Kaprin A.D., Kostin A.A., Rerberg A.G., Ivanenko K.V., Pokatilov A.A., Luchkin V.M. Anangio-interventional approach to treatmer urinary tract syndrome. Voprosi Urologii i andrologii. 2013; 2 (1):53–56. Russian (Каприн А.Д., Костин А.А., Рерберг А.Г., Иваненко К.В., Покатилов А.А., Лучкин В.М. Ангиоинтервенционный подход к лечению доброкачественной гиперплазии предстательной железы с синдромом нижних мочевых путей. Вопросы урологии и андрологии. 2013;2(1):53–56).
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  6. Shaparov B.M., Kapranov S.A., Kamalov A.A., Karpov V.K., Zlatovratskiy A.G. Super-selective prostatic arteries embolization in patients with benign prostate hyperplasia: prevention and treatment of complications. Vestnik urologii. 2021;9(4):111–121. Russian (Шапаров Б.М., Капранов С.А., Камалов А.А., Карпов В.К., Златовратский А.Г. Профилактика и лечение осложнений суперселективной эмболизации артерий предстательной железы у пациентов с ДГПЖ. Вестник урологии, 2021;9(4):111–121). doi: 10.21886/2308–6424– 2021–9-4–111–121.
  7. Pisco J.M., Pinheiro L.C., Bilhim T., Duarte M., Mendes J.R., Oliveira A.G. Prostatic arterial embolization to treat benign prostatic hyperplasia. J VascInterv Radiol. 2011;22(1):11–19. doi: 10.1016/j.jvir.2010.09.030.

Supplementary files

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2. Fig. 1. MSCT of the pelvic organs. The arrows indicate gas bubbles in the bladder wall and prostate parenchyma

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3. Fig. 2. Macropreparation of the removed bladder and prostate gland with necrotic changes

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4. Fig. 3. Microscopic picture of the presence of microemboles in the lumen of the vessels of the bladder. Staining hematoxylin eosin. Magnification of 100x.

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