前列腺动脉栓塞治疗血小板减少患者前列腺尿道提升术后输血依赖性血尿1例报告

Q4 Medicine Journal of Endourology Case Reports Pub Date : 2020-09-17 eCollection Date: 2020-01-01 DOI:10.1089/cren.2020.0031
Kyle Spradling, Sayantan Deb, William D Brubaker, Harcharan Gill, Simon Conti
{"title":"前列腺动脉栓塞治疗血小板减少患者前列腺尿道提升术后输血依赖性血尿1例报告","authors":"Kyle Spradling,&nbsp;Sayantan Deb,&nbsp;William D Brubaker,&nbsp;Harcharan Gill,&nbsp;Simon Conti","doi":"10.1089/cren.2020.0031","DOIUrl":null,"url":null,"abstract":"<p><p><b><i>Background:</i></b> 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). <b><i>Case Presentation:</i></b> 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<sup>®</sup> 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. <b><i>Conclusion:</i></b> 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.</p>","PeriodicalId":36779,"journal":{"name":"Journal of Endourology Case Reports","volume":"6 3","pages":"238-240"},"PeriodicalIF":0.0000,"publicationDate":"2020-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1089/cren.2020.0031","citationCount":"2","resultStr":"{\"title\":\"Prostate Artery Embolization Used in the Management of Transfusion-Dependent Hematuria After Prostatic Urethral Lift Procedure in a Patient with Thrombocytopenia: A Case Report.\",\"authors\":\"Kyle Spradling,&nbsp;Sayantan Deb,&nbsp;William D Brubaker,&nbsp;Harcharan Gill,&nbsp;Simon Conti\",\"doi\":\"10.1089/cren.2020.0031\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><p><b><i>Background:</i></b> 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). <b><i>Case Presentation:</i></b> 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<sup>®</sup> 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. <b><i>Conclusion:</i></b> 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.</p>\",\"PeriodicalId\":36779,\"journal\":{\"name\":\"Journal of Endourology Case Reports\",\"volume\":\"6 3\",\"pages\":\"238-240\"},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2020-09-17\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://sci-hub-pdf.com/10.1089/cren.2020.0031\",\"citationCount\":\"2\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Endourology Case Reports\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.1089/cren.2020.0031\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2020/1/1 0:00:00\",\"PubModel\":\"eCollection\",\"JCR\":\"Q4\",\"JCRName\":\"Medicine\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Endourology Case Reports","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1089/cren.2020.0031","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2020/1/1 0:00:00","PubModel":"eCollection","JCR":"Q4","JCRName":"Medicine","Score":null,"Total":0}
引用次数: 2

摘要

背景:前列腺尿道提升术(PUL)是一种治疗由良性前列腺增生(BPH)引起的下尿路症状(LUTS)的新方法。据报道,该手术后的肉眼血尿是轻微和短暂的。本报告强调了一例PUL手术后难治性输血依赖性血尿,以及选择性前列腺动脉栓塞(PAE)的治疗。病例介绍:一名78岁的白人男性,有骨髓增生异常综合征、血小板减少症和继发于BPH的间歇性尿潴留病史,接受了PUL手术。在手术前,他接受了血小板输注,使他的血小板计数为58000 /μL。手术后第二天,他因血尿伴血块潴留住进医院。他开始持续膀胱冲洗,并被送往手术室进行血块清除和前列腺电灼。他的血小板减少症和贫血是通过输血治疗的。患者接受去氨加压素、氨基己酸和膀胱内1%明矾治疗,无好转。他回到手术室进行血块清除和前列腺光选择性汽化激光消融。他最终总共需要四次经尿道电灼治疗,但输血依赖性血尿没有改善。最终,通过介入放射学采用Embosphere®微球进行双侧PAE,解决血尿问题。栓塞术后2天出院,随访6个月无血尿或尿潴留复发。结论:对于前列腺增生引起的LUTS, PUL手术已被证明是一种有效的替代手术选择。尽管经过慎重考虑,试图减轻尿潴留,PUL仍然导致明显出血的患者与血小板减少。这是第一个强调使用双侧PAE作为控制PUL后严重难治性血尿的方法的报告。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
查看原文
分享 分享
微信好友 朋友圈 QQ好友 复制链接
本刊更多论文
Prostate Artery Embolization Used in the Management of Transfusion-Dependent Hematuria After Prostatic Urethral Lift Procedure in a Patient with Thrombocytopenia: A Case Report.

Background: 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). Case Presentation: 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. Conclusion: 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.

求助全文
通过发布文献求助,成功后即可免费获取论文全文。 去求助
来源期刊
自引率
0.00%
发文量
0
期刊最新文献
A Rare Complication of Amplatz Sheath: Amplatz Sheath Rupture During Percutaneous Nephrolithotomy. Patient's Fear of Being Infected, Another Complication of COVID-19 Outbreak: A Lesson Learned from a Case of Life-Threatening Urolithiasis. Inflammatory Pseudotumor of the Renal Pelvis. Endoscopic Management of Chyluria Caused by Pyelolymphatic Fistula After Robot-Assisted Laparoscopic Pyeloplasty. Ureteroiliac Fistula: Bleeding of Unknown Origin-Case Report and Review of the Literature.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
现在去查看 取消
×
提示
确定
0
微信
客服QQ
Book学术公众号 扫码关注我们
反馈
×
意见反馈
请填写您的意见或建议
请填写您的手机或邮箱
已复制链接
已复制链接
快去分享给好友吧!
我知道了
×
扫码分享
扫码分享
Book学术官方微信
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术
文献互助 智能选刊 最新文献 互助须知 联系我们:info@booksci.cn
Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。
Copyright © 2023 Book学术 All rights reserved.
ghs 京公网安备 11010802042870号 京ICP备2023020795号-1