Early Total Recanalization of the Prostate Artery and Reperfusion of the Prostate following Particle Embolization for Benign Prostatic Hyperplasia

Braithwaite, Simon; Boardman, Philip; Tapping, Charles R.; Macdonald, Andrew

doi:10.1016/j.jvir.2021.03.545

Cited by 4 publications

(4 citation statements)

References 3 publications

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“…Since the primary pattern of revascularization was reported to be from main prostate arteries, a more effective embolization with an additional embolic agent was suggested to reduce recanalization. 24,25 Coil embolization as an adjunct embolic agent has recently been reported as technically feasible with no adverse events. 26…”

Section: Discussion Technical Considerationsmentioning

confidence: 99%

Prostate Artery Embolization in Patients above Eighty Years Old: Clinical Efficacy and Safety

Saro

Solyman

Zaki

et al. 2022

The Arab Journal of Interventional Radiology

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Purpose Prostate artery embolization (PAE) has been established as an effective treatment option for benign prostate hyperplasia or hematuria of prostatic origin. We aim to confirm the effectiveness and safety of PAE in elderly patients aged ≥ 80 years old. Materials and Methods Between January 2014 and August 2020, PAE was attempted on 54 elderly patients with lower urinary tract symptoms (LUTS) or prostatic hematuria who were unfit for surgical treatment or opted for PAE. Outcome parameters (International Prostate Symptom Score [IPSS], quality of life [QoL] score, International Index of Erectile Function score (IIEF), maximal urinary flow rate, postvoid residual, and prostate volume) were collected and analyzed at baseline, 6 months, 1, 2, and 3 years. Results The mean patient age was 85.29 years (range: 80–98). Technical success was achieved in 50 patients (92.6%). Mean IPSS improved from 18 at baseline to 7.7, 8.5, 8.6, and 9.1 at 6 months, 1, 2, and 3 years. Mean QoL improved from 4.9 at baseline to 2.8, 1.7, and 1.5 at 6 months, 1, and 2 years. Mean prostate volume reduced from a baseline of 152.7 to 123.5 mL within 6 months and 120.5 mL after 7 months of PAE. Urinary catheter removal was successful in 13 out of 19 patients with urinary retention. PAE succeeded in stopping bleeding in 16 out of 17 patients with prostate-induced hematuria. Conclusion PAE is a feasible low-risk treatment for LUTS with or without urinary retention or prostatic hematuria in elderly patients.

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Section: Discussion Technical Considerationsmentioning

confidence: 99%

Prostate Artery Embolization in Patients above Eighty Years Old: Clinical Efficacy and Safety

Saro

Solyman

Zaki

et al. 2022

The Arab Journal of Interventional Radiology

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“…With data suggesting that symptom recurrence after PAE is predominantly from the recanalization of the main PA and occurs as early as four weeks [ 7 – 9 ], more durable strategies of embolization such as coil embolization of the main PAs should be an investigative priority. In this study, the short-term outcomes of adjunctive PA coil embolization following particle embolization are similar to the reported literature for PAE without PA coil embolization.…”

Section: Discussionmentioning

confidence: 99%

“…Despite the documented efficacy of prostatic artery embolization (PAE) for benign prostatic hyperplasia (BPH) [ 1 , 2 ], clinical recurrence occurs in 5–28% of cases [ 3 – 6 ]. In repeat PAEs, the primary pattern for revascularization of the prostate is via recanalization of the main prostatic artery (PA), occurring in 75–80% of cases and as early as four weeks after PAE [ 7 – 9 ]. Given PA revascularization is the most likely culprit for clinical recurrence, a more definitive embolization with additional embolic material has been suggested to minimize recanalization [ 8 , 10 ].…”

Section: Introductionmentioning

confidence: 99%

Adjunctive Coil Embolization of the Prostatic Arteries After Particle Embolization for Prostatic Artery Embolization

Galla

Maron

Voutsinas

et al. 2021

Cardiovasc Intervent Radiol

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Purpose To describe the feasibility, safety and short-term results of prostatic artery embolization (PAE) performed with adjunctive coil embolization of the main prostatic arteries (PA) following particle embolization. Materials and Methods A total of 95 patients who underwent PAE with adjunctive bilateral coil embolization of the PAs following particle embolization between September 2018 and May 2021 were included. The patients had a mean prostate size of 115 ± 64 ml, 18/95 with hematuria symptoms, and 16/95 with indwelling urinary catheters. Coil embolization was performed in the main PAs prior to the bifurcation into the anteromedial and posterolateral branches using detachable microcoils. International Prostate Symptoms Score (IPSS), quality of life (QOL), maximum flow rate (Qmax) and adverse events were recorded. Results IPSS were improved by − 11.2 ± 7.9 ( n = 49, P < 0.001) and QOL by − 2.4 ± 1.8 ( n = 49, P < 0.001) over a mean follow-up of 10.7 ± 7.9 weeks. Qmax did not demonstrate statistical significance. Twelve patients with hematuria (67%) showed improvement or resolution and twelve patients with indwelling or intermittent catheters (75%) were no longer catheter dependent. Two patients underwent a repeat PAE. There were no adverse events which were attributable to coil embolization. Conclusion Adjunctive coil embolization of the main PAs following particle embolization is a technically feasible technique with similar short-term clinical outcomes compared to prior studies. This novel technique warrants further prospective investigation with controls.

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“…Revascularization after microsphere embolization is known to happen. 59 A handful of studies have attempted to utilize different particles or coil after embolization to make prostatic occlusion more permanent, and longer-term follow-up is pending. 60 In this study, Galla et al did note that distal catheterization to densely packed detachable coils was feasible in one patient who required repeat PAE because the coil was nonocclusive.…”

Section: Controversy No 4: Retreatment Rates Depict a False Narrative...mentioning

confidence: 99%

Controversies in Prostate Artery Embolization: Future Best Practice

Goyal

Salem

Mouli

2022

Semin intervent Radiol

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Prevalence of lower urinary tract symptoms secondary to benign prostatic hyperplasia is correlated with age. Men seeking treatment options with a low side effect profile often turn to prostate artery embolization (PAE). PAE continues to be refined with advanced tools and optimized techniques. Nonetheless, there exist controversies in terms of best practices for the management of lower urinary track symptoms (LUTS) with PAE. These controversies are essential for medical progress. Herein we suggest best practices moving forward based on currently available data. Given extensive safety data, we recommend PAE be considered alongside medical management and as a precursor to surgery. Given demonstrated efficacy across gland sizes, PAE can be performed in a single session, ideally in a hybrid angio-CT suite, without preoperative cross-sectional imaging. PAE should be initially performed with 300- to 500-μm size particles, and instead consider exploring other particles and sizes for repeat PAE. Finally, PAE can also be considered as first-line option for recurrent disease given the efficacy and excellent safety profile. This article is not meant to purport a dogma, but rather to serve as a guide to the experienced practitioner in challenging his or her own biases when performing PAE.

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Early Total Recanalization of the Prostate Artery and Reperfusion of the Prostate following Particle Embolization for Benign Prostatic Hyperplasia

Cited by 4 publications

References 3 publications

Prostate Artery Embolization in Patients above Eighty Years Old: Clinical Efficacy and Safety

Prostate Artery Embolization in Patients above Eighty Years Old: Clinical Efficacy and Safety

Adjunctive Coil Embolization of the Prostatic Arteries After Particle Embolization for Prostatic Artery Embolization

Controversies in Prostate Artery Embolization: Future Best Practice

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