Persistent prostatic hematuria

Prostatic hematuria can be a challenging clinical problem. In this Review we discuss the spectrum of methods for diagnosing prostatic hematuria and the pharmacologic and minimally invasive therapies currently available to treat primary disease and refractory cases. Before making a diagnosis and starting therapy, however, other, nonprostatic sources of hematuria must be ruled out. As part of diagnosis all patients should undergo a formal cystoscopy. Therapy should include functional and biochemical approaches. Inhibitors of 5-alpha-reductase have been shown to successfully treat prostatic hematuria when it is caused by benign prostatic hyperplasia. Intravesical instillations, using agents such as alum, silver nitrate and formalin, have been used as second-line therapies, with limited success. A novel, minimally invasive method, termed selective arterial prostatic embolization, offers another option for treating prostatic hematuria. Using interventional radiologic techniques during selective arterial prostatic embolization enables selective catheterization of the prostatic arterial circulation with subsequent embolization. This approach can rapidly stop hematuria. If more-invasive therapy is required, transurethral resection, or vaporization of the prostate and clot evacuation, should be performed before embolization or other surgical interventions.