Carbon Dioxide Angiography for Prostatic Artery Embolization in a Patient with Massive Prostatomegaly and Chronic Kidney Disease.

Abstract

embolization (PAE) effectively treats lower urinary tract symptoms related to BPH and relieves urinary obstruction but requires angiography, typically with iodinated contrast material, which is relatively contraindicated in CKD. This case of obstructive uropathy was treated with PAE performed with predominantly carbon dioxide (CO2) contrast material. Institutional review board approval was not required for this report. A 70-year-old man with massive prostatomegaly had a 20-year history of lower urinary tract symptoms and secondary bladder dysfunction, managed with clean intermittent catheterization. He presented with severe hematuria requiring 7 units of packed red blood cells, bladder outlet obstruction requiring Foley catheter placement, and continuous bladder irrigation with resultant acute-on-chronic kidney injury and a creatinine concentration peaking at 4.3 mg/dL. The patient was known to have stage IV CKD with baseline creatinine in the range of 2.3–2.6 mg/dL, secondary to obstructive Figure 2. Carbon dioxide angiography in 45! oblique orientation demonstrating the left prostatic artery (white arrows) arising from the gluteal-pudendal trunk (dashed white arrow). LT 1⁄4 left side.