Treatment of a patient with post-TURP hemorrhage using bilateral SAPE.

BACKGROUND: A 74-year-old man developed severe, life-threatening bleeding refractory to endoscopic fulguration from a prostatic capsular perforation while undergoing transurethral resection of prostate (TURP) for complicated benign prostatic hyperplasia. At the time of the procedure the patient had several comorbidities, including hypertension and associated nephropathy, and erectile dysfunction. INVESTIGATIONS: CT angiography and pelvic arteriography. DIAGNOSIS: Post-TURP arterial hemorrhage refractory to conventional methods of hemostasis, complicated by TURP syndrome and disseminated intravascular coagulopathy. MANAGEMENT: Bilateral selective arterial prostatic embolization, after endoscopic hemostasis and continuous catheter balloon traction failed to stop the hemorrhage.