A Review of Adverse Events Related to Prostatic Artery Embolization for Treatment of Bladder Outlet Obstruction Due to BPH

Moreira, Aírton Mota; Assis, André Moreira de; Carnevale, Francisco César; Antunes, Alberto A.; Srougi, Miguel; Cerri, Giovanni Guido

doi:10.1007/s00270-017-1765-3

Cited by 80 publications

(63 citation statements)

References 66 publications

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“…A postembolization syndrome, which can include pain, dysuria, frequency, and other irritative symptoms, is anticipated following PAE. These effects typically last less than 1 week and require only symptomatic management (57). Minor complications requiring therapy include acute urinary retention requiring temporary catheterization in 2.5%-4.6% of patients and urinary tract infection requiring oral antibiotic therapy in 2.6%-7.6% of patients (51).…”

Section: Safety Of Paementioning

confidence: 99%

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Society of Interventional Radiology Multisociety Consensus Position Statement on Prostatic Artery Embolization for Treatment of Lower Urinary Tract Symptoms Attributed to Benign Prostatic Hyperplasia: From the Society of Interventional Radiology, the Cardiovascular and Interventional Radiological Society of Europe, Société Française de Radiologie, and the British Society of Interventional Radiology

McWilliams

Bilhim²,

Carnevale

et al. 2019

Journal of Vascular and Interventional Radiology

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BPH ¼ benign prostatic hyperplasia, IIEF ¼ International Index of Erectile Function, IPSS ¼ International Prostate Symptom Score, LUTS ¼ lower urinary tract symptoms, MIST ¼ minimally invasive surgical therapies, OP ¼ open prostatectomy, PAE ¼ prostatic artery embolization, PVR ¼ postvoid residual, QOL ¼ quality of life, RCT ¼ randomized controlled trial, TURP ¼ transurethral resection of the prostate, UK-ROPE ¼ United Kingdom Register of Prostate Embolization BACKGROUND Benign prostatic hyperplasia (BPH) describes the proliferation of the glandular and stromal tissue in the transition zone of the prostate, which may result in bladder outlet obstruction and consequent lower urinary tract symptoms (LUTS). The prevalence of BPH increases with age, affecting more than 70% of men older than 70 years (1), and one fourth of men older than 70 years have moderate to severe LUTS that impair their quality of life (QOL) (2,3). Thus, BPH and ensuing LUTS represent a significant health issue affecting millions of men. The International Prostate Symptom Score (IPSS; also known as the American Urologic Association Symptom Index) is a validated instrument that quantifies a patient's subjective urinary symptoms on a 35-point scale (4). The IPSS also incorporates a urinary QOL score, which assesses how the patient feels overall about his urinary symptoms. Nearly all studies assessing BPH treatments for LUTS use the IPSS and QOL scores to assess patients before and after treatment. A 3-point change in IPSS is noticeable by a man with LUTS (5), and a 30% reduction in IPSS is considered clinically acceptable for a treatment to be considered effective (6,7). Medical therapies, including a-1 blockers and 5-a reductase inhibitors, are the mainstay of treatment for mild to moderate LUTS. The symptomatic relief is relatively modest, with IPSS improvement in the range of 3-7 points (8). Although generally considered safe, medical

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Section: Safety Of Paementioning

confidence: 99%

“…Major complications following PAE are rare. In review of more than 2,000 patients in the 17 unique cohort studies and 6 comparative trials, a total of 6 major complications were encountered (Table 3) (30,50,57,58). Two cases required surgical intervention; both were cases of bladder ischemia requiring partial resection (30,50).…”

Section: Safety Of Paementioning

confidence: 99%

Society of Interventional Radiology Multisociety Consensus Position Statement on Prostatic Artery Embolization for Treatment of Lower Urinary Tract Symptoms Attributed to Benign Prostatic Hyperplasia: From the Society of Interventional Radiology, the Cardiovascular and Interventional Radiological Society of Europe, Société Française de Radiologie, and the British Society of Interventional Radiology

McWilliams

Bilhim²,

Carnevale

et al. 2019

Journal of Vascular and Interventional Radiology

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“…Die Effektivität der Embolisation scheint sowohl mit kleinen als auch großen Partikeln gleichwertig zu sein [34]. Allerdings ergeben sich Hinweise, dass bei Verwendung von kleineren Partikeln (100-300 µm) etwas häufiger unerwünschte Ereignisse auftreten [35]. Dies ist in erster Linie durch eine tiefere Penetration der kleineren Partikel zu erklären, die wohl eine stärkere ischämische und dementsprechend auch eine größere nekrotische Wirkung nach sich ziehen.…”

Section: Embolisationstechnikunclassified

Position Paper of the German Society for Interventional Radiology (DeGIR) on Prostatic Artery Embolization

Kovács¹,

Bücker

Grimm

et al. 2020

Rofo

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Background In recent years prostate artery embolization (PAE) evolved into a clinically established minimally invasive endovascular treatment option for lower urinary tract symptoms caused by benign prostate syndrome (BPS). Methods In this interdisciplinary position paper, initiated by the steering group for research of the German Society for Interventional Radiology (IR), the method of PAE is presented and discussed in the context of current evidence. Results PAE is a safe IR procedure for the treatment of BPS. In terms of symptom relief, measured with the IPSS (International Prostate Symptom Score), the PAE has comparable effect, similar to the historic gold standard, transurethral resection (TUR) of the prostate. With regard to reducing subvesical obstruction PAE is inferior to TUR, but does not limit subsequent surgery. Based on current evidence, PAE is recommended by the British National Institute for Health and Care Excellence as an alternative therapy. The feasibility under local anaesthesia and the preservation of sexual function are important arguments for patients in favour of interventional therapy. Patient selection and therapy concepts require close interdisciplinary collaboration between urologists and radiologists. Conclusion Effectiveness and safety of PAE for the treatment of BPS are proven. Further randomized trials should focus on long term outcome and help to identify most suitable indications for PAE. Key Points: Citation Format

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“…In the case of PAE, this requires intraprocedural cone beam CT (CBCT) to confirm catheter placement and exclude nontarget embolization. 18,22 In fact, CBCT provides essential information not seen during digital subtraction angiography (DSA) alone in 60.8% of cases. 18 Additionally, a recent study demonstrated that CBCT identifies the PA with improved discrimination and less radiation dose than conventional preprocedural CTA.…”

Section: Cone Beam Ctmentioning

confidence: 99%

“…This typically consists of urinary frequency and dysuria lasting up to 5 days. 22 Patients are subsequently seen 1, 3, 6, and 12 months following PAE for clinical assessment. Imaging assessment with postprocedural MRI is obtained at 6 months if comparative preprocedural imaging is available.…”

Section: Post-procedural Managementmentioning

confidence: 99%