Minimally Invasive Management of Postoperative Bleeding After Radical Prostatectomy: Transarterial Embolization

Background And Purpose: Severe postoperative bleeding after radical prostatectomy is a rare, but serious, complication. Massive postoperative bleeding causing hemodynamic instability necessitates open surgical exploration and can be associated with considerable morbidity. We report our experience with minimally invasive management of postprostatectomy hemorrhage via transarterial embolization (TAE).

Patients And Methods: From July 2006 to April 2009, men with severe immediate postoperative bleeding that caused hemodynamic instability after radical prostatectomy were enrolled. We performed emergency angiography and superselective TAE instead of surgical exploration as the initial management. TAE was performed using an enbucrilate:ethiodized poppy seed oil 1:3 mixture. We determined treatment success rate, efficacy, and safety.

Results: A total of 4 among 563 (0.7%) patients had postoperative bleeding that fit the inclusion criteria in this period. CT angiography revealed active bleeding in all cases. All patients were successfully treated with TAE without any additional treatment, such as surgical exploration, and there was no treatment-related adverse event. Three (75%) patients regained continence within 6 months. Two (50%) patients were potent at 12-month follow-up.

Conclusion: During a 3-year period, we successfully treated all patients who had severe immediate postoperative bleeding after radical prostatectomy with TAE. We concluded that rapid diagnosis by CT angiography and early TAE could replace surgical exploration in this situation. In addition, this could minimize the morbidity associated with severe bleeding, transfusion, and open surgical exploration.