OBJECTIVE: Gross hematuria in the immediate postoperative radical prostatectomy is a rare complication.
According to different series reviewed, significant bleeding after this surgery appears between 0.5-1.5% of the cases.
METHODS: 58 year old male with localized prostate cancer who underwent open radical prostatectomy with preservation of the neurovascular bundles and a left accessory pudendal branch. In the 4th postoperative day patient presented severe hematuria and urethral bleeding requiring continuous bladder irrigation and blood transfusion. Given the persistence of bleeding despite conservative measures CT-angiography was performed demonstrating active bleeding at a bulbar artery from the left internal pudendal artery without associated pelvic hematoma.
RESULTS: Given the findings selective embolization was performed with absorbable material stopping the bleeding. Three months later the patient maintains urinary continence and erectile function with tadalafil.
CONCLUSIONS: Urethral bleeding after radical prostatectomy is a rare complication the cause of which is distal to the urinary sphincter unrelated to the pelvic vessels. The performance of CT angiography and subsequent embolization is the treatment of choice, avoiding open surgical revision, with less morbidity.
Molina Escudero R, Herranz Amo F, Aragón Chamizo J, Hernandez Fernández C. Are you the author?
Servicio Urología, Hospital General Universitario Gregorio Marañón, Madrid, España.
Reference: Arch Esp Urol. 2014 Jul;67(6):582-585.
Article in English, Spanish.