Spradling Kyle, Deb Sayantan, Brubaker William D, Gill Harcharan, Conti Simon
Department of Urology, Stanford University School of Medicine, Stanford, California, USA.
J Endourol Case Rep. 2020 Sep 17;6(3):238-240. doi: 10.1089/cren.2020.0031. eCollection 2020.
The prostatic urethral lift (PUL) procedure is a novel therapeutic method to treat lower urinary tract symptoms (LUTS) caused by benign prostatic hyperplasia (BPH). Gross hematuria after this procedure has been reported to be mild and transient. This report highlights a case of refractory transfusion-dependent hematuria after the PUL procedure in addition to its management with selective prostatic arterial embolization (PAE). A 78-year-old Caucasian man with a history of myelodysplastic syndrome, thrombocytopenia, and intermittent urinary retention secondary to BPH underwent a PUL procedure. Before the procedure he received a platelet transfusion making his platelet count 58,000/μL. The day after the procedure he was admitted to a hospital for gross hematuria with clot retention. He was started on continuous bladder irrigation and taken to the operating room for clot evacuation and fulguration of prostate. His thrombocytopenia and anemia were managed with transfusions. He was treated with desmopressin, aminocaproic acid, and intravesical 1% alum without improvement. He returned to the operating room for clot evacuation in addition to photoselective vaporization of the prostate laser ablation of the prostatic fossa. He eventually required a total of four transurethral fulgurations without improvement in transfusion-dependent hematuria. Ultimately, resolution of the hematuria was achieved through bilateral PAE with Embosphere Microspheres performed by interventional radiology. He was discharged home 2 days after the embolization procedure without recurrence of hematuria or urinary retention at a 6-month follow-up visit. The PUL procedure has been shown to be an effective alternative to more invasive surgical options for LUTS caused by BPH. Despite careful consideration in an attempt to alleviate urinary retention, PUL still resulted in significant bleeding in this patient with thrombocytopenia. This is the first report to highlight the use of bilateral PAE as a method for achieving control of severe refractory hematuria after PUL.
前列腺尿道悬吊术（PUL）是一种治疗良性前列腺增生（BPH）所致下尿路症状（LUTS）的新型治疗方法。据报道，该手术后的肉眼血尿症状较轻且为一过性。本报告重点介绍了1例PUL术后出现难治性输血依赖型血尿的病例及其采用选择性前列腺动脉栓塞术（PAE）的治疗过程。一名78岁的白人男性，有骨髓增生异常综合征、血小板减少症病史，因BPH继发间歇性尿潴留，接受了PUL手术。术前他接受了血小板输注，使血小板计数达到58,000/μL。术后第1天，他因肉眼血尿伴血块潴留入院。开始持续膀胱冲洗，并被送往手术室进行血块清除和前列腺电灼术。通过输血对其血小板减少症和贫血进行治疗。给予他去氨加压素、氨基己酸和膀胱内灌注1%明矾治疗，但病情无改善。除前列腺激光汽化术对前列腺窝进行光选择性汽化外，他还返回手术室进行血块清除。最终，他总共进行了4次经尿道电灼术，但输血依赖型血尿仍无改善。最终，通过介入放射科采用Embosphere微球进行双侧PAE，血尿得以缓解。栓塞术后2天他出院回家，6个月随访时血尿和尿潴留均未复发。PUL手术已被证明是治疗BPH所致LUTS的一种有效的、侵入性较小的手术替代方案。尽管为缓解尿潴留进行了仔细考虑，但PUL手术仍导致这名血小板减少症患者出现大量出血。这是第一份强调使用双侧PAE作为控制PUL术后严重难治性血尿方法的报告。
