Acute hemorrhage with huge extraperitoneal hematoma following transrectal prostate biopsy: indication for emergency prostatectomy – a case report

TL;DR

A rare case of severe bleeding after a prostate biopsy was successfully treated with emergency prostate surgery, highlighting the importance of prompt action in such situations.

Contribution

First reported case of emergency robot-assisted radical prostatectomy for post-biopsy extraperitoneal hematoma.

Findings

Emergency prostatectomy effectively controlled bleeding and provided oncologic treatment in a case of large extraperitoneal hematoma.

The patient recovered well with satisfactory continence and negative cancer margins after the procedure.

The case highlights the importance of recognizing atypical post-biopsy symptoms and considering surgical intervention when necessary.

Abstract

Prostate biopsy is generally safe, and extraperitoneal hematomas are extremely rare. We report the first known case of ongoing post-biopsy bleeding managed with emergency robot-assisted radical prostatectomy. A 77-year-old man developed acute hemodynamic instability several hours after a transrectal MRI/US-fusion biopsy. Computed tomography revealed a large left-sided extraperitoneal hematoma displacing the bladder without arterial extravasation. Despite resuscitation, hemoglobin continued to decrease, suggesting persistent venous bleeding. Preliminary histology confirmed well-differentiated acinar adenocarcinoma. Given hematoma size, instability, and confirmed malignancy, interdisciplinary consensus favored surgical management. Within 24 h, the patient underwent extraperitoneal bilateral nerve-sparing radical prostatectomy with complete hematoma evacuation. The procedure was uncomplicated, recovery stable, continence satisfactory, and final pathology showed pT2c Gleason 3 + 3 = 6 cancer with negative margins. This case underscores the need for vigilance regarding atypical post-biopsy symptoms and shows that emergency prostatectomy may offer both hemostasis and definitive oncologic treatment.

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