Holmium laser enucleation of the prostate and prostate artery embolisation: Complimentary modalities in the management of intractable prostatic bleeding

Abstract

Objectives:

We report on the outcomes following holmium laser enucleation of the prostate (HoLEP) and/or prostate artery embolization (PAE) for patients with catastrophic haematuria secondary to prostatic bleeding.

Patients & Methods:

A retrospective review of all patients receiving HoLEP and/or PAE between April 2023 and 2025 for prostatic bleeding was performed in our tertiary centre. We report on outcomes following intervention.

Results:

Eleven patients were included with prostate volumes > 100cc: seven received HoLEP, three PAE and one received HoLEP after PAE. Median (interquartile range [IQR]) time from admission to procedure was 6 days (4–11) and 11 days (7–13) for HoLEP and PAE, respectively. All patients had successful resolution of haematuria; median time from procedure to resolution was 1 day (1–2) and 1 day (1–1), and median length of stay was 10 days (8–14) and 13 days (8–17), for HoLEP and PAE respectively. Six patients required transfusion during admission, median (IQR) pre-operative Hb drop was 14 g/L (5–21) and successful trial without a catheter was performed on all patients. One patient developed a hospital-acquired pneumonia; another required an urgent HoLEP following PAE for ongoing haematuria on day 8.

Conclusions:

Within our unit, urgent HoLEP and PAE are complementary management options for patients with intractable bleeding from significantly enlarged prostates. Timely intervention prior to the procedure is vital in the safe management of such patients.

Keywords

benign prostatic enlargement haematuria enucleation HoLEP PAE embolisation

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