Observational Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jun 26, 2024; 12(18): 3438-3443
Published online Jun 26, 2024. doi: 10.12998/wjcc.v12.i18.3438
Application of prostate resectoscope in the treatment of massive rectal bleeding after transrectal prostate puncture
Hong-Mei Li, Fa-Ying Yang, Song Tu, Peng Yan, Jun Qian, Jia-Xi Yao
Hong-Mei Li, Fa-Ying Yang, Song Tu, Jun Qian, Jia-Xi Yao, Department of Urology, Hexi University Affiliated Zhangye People’s Hospital, Hexi University, Zhangye 734000, Gansu Province, China
Peng Yan, Department of General Surgery II, Hexi University, Zhangye 734000, Gansu Province, China
Author contributions: Li HM and Yang FY collected data and wrote and edited the manuscript; Tu S and Yan P analyzed the data; Qian J and Yao JX conceptualized and supervised the study; all authors have read and approved the final manuscript.
Supported by President Fund Innovation Team Project of Hexi University, No. CXTD2022012; and Gansu Province Education Technology Innovation Project, No. 2023B-163.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of Hexi University Affiliated Zhangye People’s Hospital.
Informed consent statement: Informed consent was obtained from the patients before the publication of this case series.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jia-Xi Yao, MD, PhD, Surgeon, Department of Urology, Hexi University Affiliated Zhangye People’s Hospital, Hexi University, No. 67 West Ring Road, Ganzhou District, Zhangye 734000, Gansu Province, China. 16111210057@fudan.edu.cn
Received: March 10, 2024
Revised: April 28, 2024
Accepted: May 14, 2024
Published online: June 26, 2024
Processing time: 99 Days and 20.9 Hours
Abstract
BACKGROUND

Ultrasound-guided prostate biopsy is a reliable diagnostic procedure for prostate cancer diagnosis with minimal procedure-related trauma. However, complications, such as massive rectal bleeding may occur after the puncture. We hypothesized that using a transrectal resectoscope could help treat massive rectal bleeding after transrectal prostate punctures.

AIM

To identify a simple and effective treatment for massive rectal bleeding after transrectal prostate punctures.

METHODS

Patients requiring treatment for massive rectal bleeding after transrectal prostate punctures were included. A SIMAI resectoscope was inserted through the anus. Direct electrocoagulation was performed for superficial bleeding points. Part of the rectal mucosa or surface muscle layer was removed to expose deep bleeding points, followed by electrocoagulation. An electric cutting ring was used to compress and stop the bleeding for jet-like points before electrocoagulation. The fluid color in the drainage tube was monitored postoperatively for continuous bleeding.

RESULTS

Eight patients were included from 2012 to 2022. None of the patients with massive rectal bleeding after the transrectal prostate punctures improved with conventional conservative and blood transfusion treatments. Two patients had an inferior artery embolism, and digital subtraction angiography was ineffective. All patients received emergency transanal prostate resection, which immediately stopped the bleeding. Four days after the procedure, the patients had recovered and were discharged.

CONCLUSION

Using a transanal prostate resection instrument is a simple, safe, and effective method for treating massive rectal bleeding after transrectal prostate punctures.

Keywords: Electrocoagulation; Hemostasis; Transanal prostate resection instrumentation; Prostate puncture

Core Tip: This report describes the treatment of eight patients with massive rectal bleeding after a transrectal prostate puncture using a prostate resectoscope. After massive rectal bleeding, in addition to systemic treatment, the commonly used local treatment methods are often ineffective or traumatic, risking further aggravation. Herein, we describe our experience using a prostate resectoscope to successfully treat superficial, deep, and jet-like bleeding points in patients with massive rectal bleeding after a transrectal prostate puncture, presenting a novel and minimally invasive treatment approach with several advantages over other surgical treatment methods.