Favorable Outcome of Conservative Management of Extensive Bladder Ischemia Complicating Prostatic Artery Embolization

This is a report of a case of bladder ischemia which complicated bilateral prostatic artery embolization in an 80-year-old man with benign prostate hyperplasia and indwelling bladder catheter. Reflux of 100 μm microspheres into superior vesical arteries was the most likely cause. An unenhanced computed tomography (CT) scan performed immediately post-embolization showed retention of contrast in the left anterolateral bladder wall. Five days later, CT showed gas collections and dehiscence of the bladder wall at the same site, involving an area of 47 × 42 mm. Treatment included prolonged (6 weeks) bladder catheterization and antibiotics. Partial resolution of the CT findings and 43% reduction in the prostatic volume were noted after that period; no leakage was detected on ascending cystogram, and the patient was capable of spontaneous micturition.