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. 2018 Oct 24;18(1):92.
doi: 10.1186/s12894-018-0407-7.

Seminal vesicle abnormalities following prostatic artery embolization for the treatment of benign prostatic hyperplasia

Jin Long Zhang  1   2 , Kai Yuan  2 , Mao Qiang Wang  3   4 , Jie Yu Yan  2 , Yan Wang  2 , Guo Dong Zhang  2
Affiliations

Seminal vesicle abnormalities following prostatic artery embolization for the treatment of benign prostatic hyperplasia

Jin Long Zhang et al. BMC Urol. .

Abstract

Background: Prostatic artery embolization (PAE) has been proved effective in the treatment of lower urinary tracts (LUTS) secondary to benign prostatic hyperplasia (BPH) with low complications, and most of the them are due to non-target embolization of adjacent organs, such as bladder, rectum, seminal vesicles and penis. Aim of this study was to present seminal vesicle (SV) abnormalities following prostatic artery embolization (PAE) for the treatment of symptomatic benign prostatic hyperplasia.

Methods: We reviewed 139 BPH patients who received PAE during the period of February 2009 and January 2015 at a single institution, highlighting seminal vesicle abnormalities and their clinical relevance after PAE. PAE was performed using 90~ 180-μm (mean 100-μm) polyvinyl alcohol foam particles.

Results: Nine of 139 patients with SV abnormalities (6.5%) were identified by magnetic resonance imaging (MRI), including subacute haemorrhage in 3 patients and ischaemia in 6 patients. Using cone-beam computed tomography (CB-CT), the seminal vesicle arteries were identified 8 of the 9 patients. All 9 patients complained of a few episodes of mild haematospermia during the 1-4 weeks after PAE; the haematospermia disappeared spontaneously without any treatment.

Conclusion: SV haemorrhage and ischaemia may occur after PAE, and these patients may present with transient and self-limited haematospermia.

Keywords: Angiography; Benign prostatic hyperplasia; Prostate artery embolization; Seminal vesicle haemorrhage; Seminal vesicle ischaemia.

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Conflict of interest statement

Ethics approval and consent to participate

This study was conducted with the approval of the hospital review boards of the Chinese People’s Liberation Army General Hospital and was performed according to the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. Written informed consent was obtained from all of the patients for the PAE procedure. Additional informed consent was not required for this retrospective study.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Seminal vesicle haemorrhage. Image from a 65-year-old man with lower urinary tract symptoms due to benign prostatic hyperplasia (BPH). He presented with mild haematospermia at 1 week after PAE that disappeared 4 weeks later without specific treatment. a Axial T1-weighted MR image obtained before PAE shows the normal appearance of the seminal vesicles (arrowheads) and BPH (straight arrow). b Axial T1-weighted MR image obtained 1 month after PAE shows high-intensity signals on the right side of the seminal vesicles (arrowhead), suggestive of haemorrhage, and BPH (straight arrows). c Axial T1-weighted MR image (without fat suppression) obtained 12 months after PAE shows iso-intensity signals on the right side of the seminal vesicles (arrowhead) and reduction in the size of the SVs. d Digital subtraction angiography (DSA) of the right prostatic artery (straight arrow) with same-side anterior oblique projection (35°) demonstrates contrast medium staining in the right prostate lobe (asterisk). e Cone-beam CT (CB-CT) with coronal view after catheterization of the right prostatic artery (straight arrow) demonstrates the small branches (curved arrow) supplying the seminal vesicles and contrast medium staining in the right prostate lobe (asterisk). f CB-CT with axial view after catheterization of the right prostatic artery (straight arrow) demonstrates the small branches (curved arrow) supplying the seminal vesicles (the seminal vesicle artery) and contrast medium staining in the right prostate lobe (asterisks)
Fig. 2
Fig. 2
Seminal vesicle ischaemia. Image from a 72-year-old patient with lower urinary tract symptoms due to a large BPH (120 mL). a Axial contrast-enhanced T1-weighted MR image obtained before PAE shows a large benign prostatic hyperplasia (straight arrow) and normal seminal vesicles (arrowheads). b Axial contrast-enhanced T1-weighted MR image obtained 1 month after PAE shows reduction of the prostate (straight arrows) and hypoperfusion in the seminal vesicles (arrowhead), suggestive of ischaemia. c DSA of the left prostatic artery (straight arrow) with same-side anterior oblique projection (35°) demonstrates contrast-medium staining in the left prostate lobe (asterisk). d CB-CT with axial view after catheterization of the left prostatic artery (straight arrow) demonstrates the small branches (curved arrow) supplying the seminal vesicles (the seminal vesicle artery) and contrast medium staining in the left prostate lobe (asterisk)
Fig. 3
Fig. 3
Seminal vesicle ischaemia. Image from a 69-year-old patient with lower urinary tract symptoms due to a large BPH (132 mL). a Coronal contrast-enhanced T1-weighted MR image obtained before PAE shows normal seminal vesicles (arrowheads). b Coronal contrast-enhanced T1-weighted MR image obtained at 1 month after PAE shows significant hypoperfusion in the seminal vesicles (arrowheads), suggestive of ischaemia
Fig. 4
Fig. 4
Images from the same patient as Fig. 3. a DSA of the right prostatic artery (curved arrow) with same-side anterior oblique projection (35°) demonstrates contrast-medium staining in the right prostate lobe (asterisk) and the small branches (straight arrow), which were suspected to be the seminal vesicle arteries. b CB-CT with coronal view after catheterization of the right prostatic artery (curved arrow) demonstrates the small branches (straight arrows) supplying the seminal vesicles. c CB-CT with axial view after catheterization of the right prostatic artery (curved arrow) demonstrates the small branches (straight arrows) supplying the seminal vesicles (the seminal vesicle arteries) and contrast medium staining in the prostate (asterisks)
See this image and copyright information in PMC

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