E5377. An Institution’s Experience: Prostate Artery Embolization in Refractory Hematuria of Prostatic Origin
  1. Mark Wright; University of Nebraska Medical Center
  2. Harvey Sekhon; University of Nebraska Medical Center
  3. Will Roeder; University of Nebraska Medical Center
  4. Lei Yu; University of Nebraska Medical Center
Refractory hematuria of prostatic origin (RHPO) is an uncommon yet potentially life-threatening entity with etiologies including iatrogenic causes, trauma, benign prostatic hypertrophy, prostatitis, and malignancy. With improved medical technology and imaging capabilities, there are increased urologic interventions and significant improvement in patient survival over time, which lead to increased incidence of RHPO requiring intervention. The purpose of this educational exhibit is to demonstrate the utility of prostate artery embolization (PAE) in the setting of RHPO refractory to medical management. We will highlight several cases from our large academic medical center with associated imaging, diagnostic work-up with considerations for alternative management, and clinical outcomes.

Educational Goals / Teaching Points
The educational goals of this exhibit include increasing the viewer’s familiarity and ability to recognize cases of RHPO amenable to prostate artery embolization. We highlight several cases from our institution and review prostate artery anatomy with important anatomic variants, clinical management, indications for PAE, and technical considerations.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Imaging modalities will include the use of CTA, cone beam CT with embolization guidance software, and intraprocedural fluoroscopic imaging in the management of RHPO. Cone beam CT demonstrates perfusion of the prostate gland and identifies variant anatomy supplying tissues other than the prostate gland (i.e., rectum, bladder, and/or penis). Prophylactic coil embolization of the vesicle artery or rectal artery branches is discussed to avoid nontarget embolization. Each of our cases will demonstrate key imaging findings, variations in the prostate artery origin, clinical decision-making, and treatment strategies. Posttreatment clinical courses, management, and follow-up will be included. Presented cases include RHPO in a patient with recent coronary artery bypass grafting and deep vein thrombosis requiring chronic anticoagulation, iatrogenic etiologies, and malignancy-associated bleeding.

PAE is a safe and effective treatment for RHPO with relatively low risk of complications. We hope to demonstrate cases of PAE with discussion of clinical decision making, utility of multiple imaging modalities, including the use of cone beam CT to identify variant anatomy and avoid nontarget embolization.