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

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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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作者简介

A. Podoynicin

MONIKI

编辑信件的主要联系方式.
Email: a4955145801@gmail.com

д.м.н., руководитель отделения урологии

俄罗斯联邦, Moscow

E. Mamedov

MONIKI

Email: elvin_mammadli@mail.ru

к.м.н., заведующий отделением урологии

俄罗斯联邦, Moscow

N. Amosov

MONIKI

Email: Nikita_amosov@mail.ru

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

俄罗斯联邦, Moscow

S. Garmash

MONIKI

Email: 89262343904@mail.ru

к.м.н., заведующий отделением онкоурологии

俄罗斯联邦, Moscow

D. Kuznecova

MONIKI

Email: dasha_kuzn96@mail.ru

аспирант кафедры урологии

俄罗斯联邦, Moscow

E. 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

俄罗斯联邦, Moscow

G. 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

俄罗斯联邦, Moscow

P. Maltsagova

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

Email: dasha_kuzn96@mail.ru

студентка 6 курса лечебного факультета

俄罗斯联邦, Moscow

参考

  1. Yakovets E.A., Neymark A.I., Karpenko A.A., Yakovets Ya.V. Prostatic artery embolization in treatment of patients with prostate adenoma and high surgical risk. Andrologiya i genitalnaya khirurgiya 2010;1:38–43. Russian (Яковец Е.А., Неймарк А.И., Карпенко А.А., Яковец Я.В. Эмболизация артерий предстательной железы в лечении больных аденомой предстательной железы с высоким хирургическим риском. Андрология и генитальная хирургия. 2010;(1):38–43).
  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).
  3. Wang M.Q., Guo L.P., Zhang G.D., Yuan K., Li K., Duan F., et al. Prostatic arterial embolization for the treatment of lower urinary tract symptoms due to large (> 80 mL) benign prostatic hyperplasia: results of midterm follow-up from Chinese population. BMC Urol. 2015;15:33. doi: 10.1186/s12894-015-0026-5.
  4. Pisco J., Campos Pinheiro L., Bilhim T., Duarte M., Rio Tinto H., Fernandes L., et al. Prostatic arterial embolization for benign prostatic hyperplasia: short- and intermediate-term results. Radiology. 2013;266(2):668–677. doi: 10.1148/radiol.12111601.
  5. Chen C.B., Chou C.T., Chen Y.L. Cone-beam CT findings during prostate artery embolization for benign prostatic hyperplasia-induced lower urinary tract symptoms: a case report. BMC Urol. 2017;17(1):120. doi: 10.1186/s12894-017-0311-6.
  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.

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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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