Outcome after prostatic artery embolization in patients with symptomatic benign prostatic hyperplasia

Abstract

Background Prostatic artery embolization (PAE) has recently been described as a promising alternative treatment for lower urinary tract symptoms (LUTS) due to an enlarged, benign prostate. Purpose To evaluate the safety, morbidity, and functional outcomes after PAE. Material and Methods Twenty-nine consecutive patients were included. All patients had computed tomography angiography before the procedure. Microcatheters were used for selective embolization of the PAs. Large side branches to non-target organs were embolized with coils. The PAs were embolized with calibrated 300–500 µm tris-acryl gelatin microspheres. Complications were recorded before discharge. Clinical visit was performed after three months, magnetic resonance imaging (MRI) after 6–12 months, and any further intervention recorded in the chart. Mean follow-up was 23 months. Clinical success was defined as no longer needing urinary catheter, no long-term complications, and no need of further interventions. Results Sixteen patients (55%) had permanent or intermittent catheter before the procedure. Bilateral embolization was performed in 26 patients (90%). Five patients underwent two procedures. Twelve of 16 patients (75%) with permanent or intermittent catheter were able to remove the catheter. Five patients were operated with transurethral resection of the prostate (TURP). Except for one patient, all patients without catheter at baseline improved in the International Prostate Symptom Score (IPSS) and had no further treatment. Twelve patients experienced complications; all were grade 1 according to the Clavien–Dindo classification. Conclusion PAE reduced LUTS symptoms in most patients without severe complications. The treatment did not exclude additional surgical treatment when needed.

Safety and efficacy of prostatic artery embolization for large benign prostatic hyperplasia in elderly patients

“…Consistent with the findings of previous investigations, 6,12–14 our study showed that PAE is an efficacious treatment for LUTS secondary to large prostate volume (>80 mL) in elderly patients (≥80 years of age) who were not suitable candidates for open or endoscopic surgical procedures; notably, we found that this surgical approach had a favorable safety profile. All six of the monitored functional results were significantly improved at 12 months postoperatively in the present study, similar to the results reported by Gao et al.…”

“…PAE was proposed relatively recently and has been the focus of increasing interest in both radiological and urological communities since its first successful use for BPH with acute urinary retention in 2010. 7 Consistent with the findings of previous investigations, 6,[12][13][14] our study showed that PAE is an efficacious treatment for LUTS secondary to large prostate volume (>80 mL) in elderly patients (!80 years of age) who were not suitable candidates for open or endoscopic surgical procedures; notably, we found that this surgical approach had a favorable safety profile. All six of the monitored functional results were significantly improved at 12 months postoperatively in the present study, similar to the results reported by Gao et al 9 Furthermore, Lebdai et al 15 reported a mean reduction in IPSS of 11.9 points at 1 month postoperatively, which persisted at 6 months postoperatively.…”

Postembolization Syndrome after Prostatic Artery Embolization: A Systematic Review

“…A total of 263 articles were removed after reading the abstract. Of the remaining 115 studies assessed for full-text eligibility, 32 studies with a total of 2116 patients (ranging from 11–199) were selected for data extraction [ 5 , 6 , 7 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 ]. A PRISMA flow diagram depicts the process of study selection ( Figure 1 ).…”

“…In this review, the incidence of urinary tract infections (UTIs) requiring antibiotic treatment as reported by 20 studies was 2.7% (SD 3.7). Seven studies recorded no UTIs and the highest UTI percentage of 13.8% was reported in a study by Kløw et al [ 35 ]. Currently, antibiotic prophylaxis covering Gram-negative rods is routinely administered prior to PAE in most centers, even though no randomized trials evaluating its efficacy exist to date.…”