Department of Urology, Suining Central Hospital, 127 Desheng West Road, Suining, 629000, Sichuan, China.
BMC Urol. 2023 Mar 4;23(1):31. doi: 10.1186/s12894-023-01201-0.
Prostate artery embolization (PAE) is a relatively safe and effective alternative method for the treatment of lower urinary tract symptoms secondary to benign prostatic hyperplasia. The adverse events caused by PAE are primarily mild, including urinary tract infection, acute urinary retention, dysuria, fever, etc. Severe complications, such as nontarget organ embolism syndrome or penile glans ischemic necrosis, are rare. Here, we report a case of severe ischemic necrosis of the glans penis after PAE and review the literature.
An 86-year-old male patient was admitted to the hospital due to progressive dysuria with gross hematuria. The patient underwent placement of a three-way urinary catheter to facilitate continuous bladder flushing, hemostasis, and rehydration. After admission, his hemoglobin decreased to 89 g/L. After an examination, the diagnosis was benign prostatic hyperplasia with bleeding. During communication with the patient regarding treatment, he requested prostate artery embolization due to his advanced age and concomitant disease status. He underwent bilateral prostate artery embolization under local anesthesia. His urine gradually turned clear. However, on the 6th day after embolization, the glans gradually showed ischemic changes. On the 10th day, there was partial necrosis and blackening of the glans. The glans completely healed, and the patient was able to urinate smoothly on the 60th day after local cleaning and debridement, the administration of pain relief, anti-inflammatory and anti-infection agents, and external application of burn ointment.
Penile glans ischemic necrosis after PAE is rare. The symptoms include pain, congestion, swelling, and cyanosis in the glans.
前列腺动脉栓塞术（PAE）是治疗良性前列腺增生引起的下尿路症状的一种相对安全有效的替代方法。PAE 引起的不良事件主要为轻度，包括尿路感染、急性尿潴留、尿痛、发热等。严重并发症如非靶器官栓塞综合征或阴茎龟头缺血性坏死罕见。本文报道 1 例 PAE 后发生严重龟头缺血性坏死的病例，并复习文献。
一名 86 岁男性患者因进行性排尿困难伴肉眼血尿入院。患者行三腔导尿管留置以方便持续膀胱冲洗、止血和补液。入院后血红蛋白降至 89g/L。入院检查后诊断为良性前列腺增生伴出血。在与患者沟通治疗方案时，由于患者年龄较大且合并疾病，他要求行前列腺动脉栓塞术。患者在局部麻醉下行双侧前列腺动脉栓塞术，术后尿液逐渐转清。但栓塞后第 6 天龟头逐渐出现缺血改变，第 10 天龟头部分坏死变黑，第 60 天局部清创、去腐后龟头完全愈合，患者排尿通畅，疼痛缓解，给予止痛、抗炎、抗感染等药物治疗，并外用烧伤膏。
PAE 后发生的阴茎龟头缺血性坏死罕见。其症状包括龟头疼痛、充血、肿胀和发绀。
