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Persistent prostatic hematuria

Nature Clinical Practice Urology volume 5, pages 159–165 (2008)Cite this article

Abstract

Prostatic hematuria can be a challenging clinical problem. In this Review we discuss the spectrum of methods for diagnosing prostatic hematuria and the pharmacologic and minimally invasive therapies currently available to treat primary disease and refractory cases. Before making a diagnosis and starting therapy, however, other, nonprostatic sources of hematuria must be ruled out. As part of diagnosis all patients should undergo a formal cystoscopy. Therapy should include functional and biochemical approaches. Inhibitors of 5-α-reductase have been shown to successfully treat prostatic hematuria when it is caused by benign prostatic hyperplasia. Intravesical instillations, using agents such as alum, silver nitrate and formalin, have been used as second-line therapies, with limited success. A novel, minimally invasive method, termed selective arterial prostatic embolization, offers another option for treating prostatic hematuria. Using interventional radiologic techniques during selective arterial prostatic embolization enables selective catheterization of the prostatic arterial circulation with subsequent embolization. This approach can rapidly stop hematuria. If more-invasive therapy is required, transurethral resection, or vaporization of the prostate and clot evacuation, should be performed before embolization or other surgical interventions.

Key Points

  • Nonprostatic causes of hematuria must always be ruled out during the diagnostic work up for prostatic hematuria

  • The treatment of prostatic hematuria should involve a multimodal approach that uses biochemical and functional therapies

  • 5-α-reductase inhibitors have been shown to decrease the mean number of days to resolution of prostatic hematuria secondary to benign prostatic hematuria

  • In patients with refractory hematuria, selective arterial prostatic embolization provides a minimally invasive treatment option

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Figure 1: Algorithm for diagnosis and management of prostatic hematuria.
Figure 2: Time to resolution of hematuria according to initial size of the prostate in 16 patients who were treated daily with finasteride.
Figure 3: Digital subtraction angiography of a patient with refractory gross hematuria of prostatic origin.

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Acknowledgements

Charles P Vega, University of California, Irvine, CA, is the author of and is solely responsible for the content of the learning objectives, questions and answers of the Medscape-accredited continuing medical education activity associated with this article.

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Authors and Affiliations

  1. AR Rastinehad is a Senior Resident, BA VanderBrink is Chief Resident in Urology, and LR Kavoussi is Chairman of Urology at the Arthur Smith Institute for Urology, North Shore–LIJ Health System, NY, MC ,

    Ardeshir R Rastinehad, Brian A VanderBrink & Louis R Kavoussi

  2. Ost is Assistant Professor in the Department of Urology, University of Pittsburgh, PA,

    Michael C Ost

  3. DN Siegel is Chief of the Division of Vascular Interventional Radiology at Long Island Jewish Medical Center, North Shore–LIJ Health System, NY, USA.,

    David N Siegel

Authors
  1. Ardeshir R Rastinehad
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  2. Michael C Ost
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  5. Louis R Kavoussi
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Correspondence to Ardeshir R Rastinehad.

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The authors declare no competing financial interests.

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Rastinehad, A., Ost, M., VanderBrink, B. et al. Persistent prostatic hematuria. Nat Rev Urol 5, 159–165 (2008). https://doi.org/10.1038/ncpuro1044

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