Patterns of Reperfusion and Clinical Findings in Repeat Prostate Artery Embolisation for Recurrent Lower Urinary Tract Symptoms in Patients with Benign Prostatic Hyperplasia

Abstract

Purpose To present our experience of the patterns of revascularisation of the prostate and efficacy of repeat prostate artery embolisation (rPAE) in patients with recurrence of lower urinary tract symptoms. Materials and Methods We retrospectively analysed 12 patients who underwent rPAE at a single centre between November 2015 and March 2020. The patients had their intraprocedural angiography and cone beam CT images as well as their pre-procedural CT retrospectively reviewed to establish the patterns of revascularisation. Clinical followup occurred at a minimum of 3 months. Results 11/12 patients (91.6%) had significant international prostate symptom score (IPSS) reduction following rPAE with change in mean IPSS from 18.4 to 8.1 at 3 months (p \ 0.0001). Mean prostate volume was reduced by 41.6% (p = 0.03). 8/12 (75%) had a complete clinical success. 20/24 hemiprostates demonstrated revascularisation angiographically, of which 16 (80%) had prostatic arterial supply at rPAE by the main prostatic artery. Other mechanisms of revascularisation included supply from capsular prostatic artery branches and supply from other internal iliac pelvic branches. Unilateral embolisation at rPAE, where bilateral embolisation was not feasible (4/12), resulted in no difference in clinical outcomes compared with bilateral rPAE (p = 0.55). Conclusion We have found rPAE to be an effective treatment for recurrent lower urinary tract symptoms in patients who had good clinical response to initial PAE. The mechanisms of revascularisation are variable, but most patients that underwent rPAE had recanalisation of their main prostatic artery.

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

“…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…”

Controversies in Prostate Artery Embolization: Future Best Practice

“…In contrast, repeat PAE has been shown to be feasible, safe, and efficacious, particularly in patients who respond to initial PAE. 56 57 It remains to be explored why a small selection of patients do not respond to initial PAE. And although repeat PAE is still shown to be safe in these patients, they may fare better from proceeding with more definitive treatments.…”

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

“…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 ]. While the majority of operators perform PAE solely with particles, the use of gelfoam as an adjunct has been previously described [ 11 ].…”