LAUSR

Dear Editor, We read with interest the paper by Moreira et al. [1], published recently in Cardiovascular and Interventional Radiology (CVIR), concerning expected and nonexpected adverse events following prostatic artery embolization (PAE). This procedure has gained in popularity in the last few years due to its low rate of morbidity and the low risk of sexual dysfunction after the intervention. It is especially useful for patients with an enlarged prostate who are not suitable for surgery. After the procedure, voiding of small prostatic gland fragments has been rarely reported, with a favorable outcome after spontaneous expulsion [2, 3]. We report the case of a patient with large prostatic fragments after embolization, requiring endoscopic retrieval. This 78-year-old man presented acute urinary retention in August 2016, during hospitalization for stroke. Catheter removal had failed, and he retained an indwelling urinary catheter. He was treated with anticoagulation and antiplatelet therapy, but considering the hemorrhagic risk, he was not eligible for surgery. A multidisciplinary team considered that PAE was an option. Preoperative MRI revealed an enlarged prostatic gland estimated at 160 ml without contraindication to the procedure. Embolization was performed in an interventional suit (Artis Zeego, Siemens, Germany) using right femoral artery access. A cone beam CT with a pigtail catheter in the distal aorta was used to plan the procedure. The left prostatic artery was branched from a common vesico-prostatic trunk, and the right prostatic artery trifurcated from the anterior hypogastric trunk. These two arteries were catheterized using a 2.0 French microcatheter (Progreat, Terumo, Japan). Embolization was performed using the ‘‘Proximal Embolization First, Then Embolize Distal’’ (PERFECTED) technique with 5 ml of 250 lm Embozene microspheres (Boston Scientific, Natick, Massachusetts, USA) for the left side and 5 ml for the right side. Immediate postoperative care was straightforward, and the patient was discharged the following day without any early complication. Three weeks after the procedure, the urinary catheter was successfully removed. During the next 3 months, the patient reported worsening of the urinary symptoms, & Julien Ghelfi [email protected]