Prostatic and scrotal necrosis following prostate artery embolization: a rare complication with a successful long-term outcome

Background: This case report highlights a rare but severe complication of prostate artery embolization (PAE)—prostate necrosis. Once successfully managed, it resulted in an optimal long-term clinical outcome. Case presentation: A 70-year-old male was diagnosed with benign prostatic hyperplasia (BPH) and presented with severe lower urinary tract symptoms (LUTS), requiring a permanent urethral catheter. One month after PAE, the patient developed extensive prostate necrosis, which was associated with scrotal cutaneous necrosis, confirmed through imaging and clinical evaluation. The patient was treated with intensive medical therapy and scrotal surgical debridement, leading to clinical improvement. The patient was discharged after one month following clinical improvements and was instructed to continue antibiotic therapy. An outpatient visit was scheduled for 6 months, where full recovery was observed, allowing for the removal of his urinary catheter. The patient was assessed at 18 months with a significant reduction in prostate volume (20 cc) and in the International Prostatic Symptoms Score (IPSS), dropping to 6. Conclusion: Prostate necrosis is an extremely rare complication of PAE. While life-threatening, if managed promptly, it can lead to an excellent long-term clinical improvement in LUTS, due to a substantial reduction in prostate volume.