[Penile necrosis, a specific complication of prostatic artery embolization]

Abstract

Introduction: Endoscopic surgery is the standard treatment for benign prostatic hyperplasia (BPH) refractory to pharmacological treatments. In order to reduce invasiveness and preserve sexual function, prostatic artery embolization (PAE) has been developed. However, the technical difficulties of carrying out this procedure and the results, which have yet to be confirmed, mean that it is not currently recommended. The seriousness of the complications generated should lead to a reflection on the benefit-risk balance. The objective is to report a case of penile ischemia after embolization of the prostatic arteries.

Material and method: A severe complication following prostatic artery embolization (PAE) is reported with its clinical and paraclinical evaluation before and after the procedure as well as the therapeutic management.

Results: Penile necrosis following prostatic artery embolization was reported in a 75-year-old patient despite an attempt of deobstruction. Lower urinary tract symptoms worsened postoperatively, associated with glans necrosis and refractory erectile dysfunction.

Conclusion: The place of PAE in the therapeutic arsenal of BPH needs to be confirmed. This innovative technique exposes the patient to potentially severe risks such as penile ischemia, not encountered in conventional endoscopic surgical treatment. PAE should not be included in the therapeutic armamentarium for BPH outside of clinical trials.

Keywords: Benign prostatic hyperplasia; Dysfonction érectile; Dysuria; Dysurie; Embolisation de l’artère prostatique; Erectile dysfunction; Hypertrophie bénigne de prostate; Necrosis; Nécrose; Prostatic artery embolization.