Postembolization Syndrome after Prostatic Artery Embolization: A Systematic Review

Svarc, Petra; Taudorf, Mikkel; Nielsen, Michael Bachmann; Stroomberg, Hein Vincent; Røder, Martin Andreas; Lönn, Lars

doi:10.3390/diagnostics10090659

Cited by 18 publications

(10 citation statements)

References 52 publications

(91 reference statements)

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“…Data specifically related to the incidence and aetiology of PES post embolisation of the uterine artery is limited. Overall the incidence of PES was found to range from 19.4% to 34.5%, which was similar to previously reported PES rate following embolisation of the prostatic artery [ 23 ]. The heterogenicity between the studies made the rate difficult to interpret.…”

Section: Discussionsupporting

confidence: 89%

“…This is commonly followed by leucopenia, leukocytosis and possible increased C-reactive protein. Further clinical studies are necessary to characterize the specific underlying mechanism pertaining to the syndrome [ 21 , 23 ]. Despite a paucity of studies concerning the specifics of the mechanism underlying PES, the current literature provides several observations that support the hypothesis of an inflammatory aetiology [ 19 , 20 ].…”

Section: Discussionmentioning

confidence: 99%

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Uterine Artery Embolisation of Fibroids and the Phenomenon of Post-Embolisation Syndrome: A Systematic Review

et al. 2022

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Post-embolisation syndrome (PES) is a prevalent complication that occurs in patients following uterine artery embolisation (UAE) for the treatment of uterine fibroids. The aetiology of PES remains incompletely understood, although postulated to result secondary to tissue infarction resulting in release of inflammatory mediators. We followed PRISMA guidelines and performed a systematic review of studies of PES following UAE from inception to October 2022. Our published protocol was prospectively registered. Our search yielded 54 results. We reviewed 22 full texts, and nine articles were included. Observational studies comprised 6/9 relevant studies, with 5/9 retrospective design. The rate of PES was documented in 5/8 studies (excluding case report) with a reported incidence ranging from 4–34.6%. Five of the nine studies studies postulated that the aetiological basis of PES is inflammatory related. Further research is necessary to advance our understanding of PES to define the biological basis of the syndrome with more certainty and gain a consensus on peri-procedure management to reduce incidence and improve patient outcomes.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Uterine Artery Embolisation of Fibroids and the Phenomenon of Post-Embolisation Syndrome: A Systematic Review

et al. 2022

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“…This condition is related to postembolization syndrome (PES) caused by necrosis and ischemic injury of normal tissue after UAE, which can provoke a systemic inflammatory response ( 8 ). Moreover, this response has also been confirmed in hepatic and splenic artery embolization ( 9 ).…”

Section: Introductionmentioning

confidence: 68%

Retrospective Analysis of the Effect of Lidocaine Combined with Methylprednisolone on Pain Control After Uterine Artery Embolization

Lin

Zhang

et al. 2022

Front. Surg.

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BackgroundThe analgesic effect produced by the intra-arterial injection of lidocaine in patients undergoing uterine artery embolization has been proven to be safe and effective. Nevertheless, a significant degree of pain is typically experienced after the operation, and pain management is crucial. Methylprednisolone, which provides an anti-inflammatory effect, is widely used in the treatment of several diseases. To date, methylprednisolone has not been used after uterine artery embolization.MethodsA total of 131 patients with uterine leiomyoma were retrospectively enrolled. Forty-five patients (control group) were treated with embolized microspheres for bilateral uterine artery embolization. Fifty (study group) and 36 (lidocaine group) patients were administered lidocaine mixed with embolized microspheres during embolization, and in addition, the study group was administered methylprednisolone. Completed pain scales at different time points during surgery were obtained from patients undergoing uterine artery embolization. Efficacy against pain was evaluated by comparing the pain score, inflammatory index, and use of sufentanil within 24 h followed by a Kruskal-Wallis Test and a least significant difference post-hoc analysis.ResultsThe postoperative pain scores at 1, 4, and 7 h after uterine artery embolization in the study group (3.08 ± 2.09, 2.46 ± 1.93, and 2.38 ± 1.85, respectively) were significantly lower than those in the control group (4.84 ± 2.36, 4.16 ± 1.87, and 3.56 ± 1.93, respectively) and the lidocaine group (3.50 ± 2.10, 3.30 ± 1.88, and 3.28 ± 1.89, respectively). At the first 24 h after embolization, the total usage of sufentanil in the study group (31.4 ± 4.16) was significantly lower than those in the control group (45.7 ± 6.51) and the lidocaine group (38.3 ± 6.25). At 1 and 4 h, the pain scores of the lidocaine group were significantly lower than those of the control group. In addition, at the first 24 h after embolization, the total usage of sufentanil in the lidocaine group was significantly lower than that in the control group.ConclusionLidocaine in combination with methylprednisolone can significantly alleviate pain and reduce the usage of sufentanil after bilateral uterine artery embolization. Thus, methylprednisolone is a recommended addition to the therapeutic regimen after embolization.

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“…The reporting of adverse events was not uniform across studies, especially of those that differ across procedures, such as ‘post‐embolization syndrome' in PAE. This was also highlighted in a recent review of observational data in which over a quarter of patients experienced this syndrome, but it was not uniformly characterized [69]. Although the Clavien–Dindo system provides a well‐established system to grade the severity of surgical complications, it may be less than ideal to characterize, for example, the adverse event profile for such different MITs as PUL and PAE.…”

Section: Discussionmentioning

confidence: 99%

Minimally invasive treatments for benign prostatic hyperplasia: a Cochrane network meta‐analysis

et al. 2021

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To assess the comparative effectiveness and ranking of minimally invasive treatments (MITs) for lower urinary tract symptoms (LUTS) in men with benign prostatic hyperplasia (BPH). Materials and MethodsWe searched multiple databases up to 24 February 2021. We included randomized controlled trials assessing the following treatments: convective radiofrequency water vapour thermal therapy (WVTT; or Rez um); prostatic arterial embolization (PAE); prostatic urethral lift (PUL; or Urolift); temporary implantable nitinol device (TIND); and transurethral microwave thermotherapy (TUMT) compared to transurethral resection of the prostate (TURP) or sham surgery. We performed a frequentist network meta-analysis. ResultsWe included 27 trials involving 3017 men. The overall certainty of the evidence of most outcomes according to GRADE was low to very low. Compared to TURP, we found that PUL and PAE may result in little to no difference in urological symptoms, while WVTT, TUMT and TIND may result in worse urological symptoms. MITs may result in little to no difference in quality of life, compared to TURP. MITs may result in a large reduction in major adverse events compared to TURP. We were uncertain about the effects of PAE and PUL on retreatment compared to TURP, however, TUMT may result in higher retreatment rates. We were very uncertain of the effects of MITs on erectile function and ejaculatory function. Among MITs, PUL and PAE had the highest likelihood of being the most efficacious for urinary symptoms and quality of life, TUMT for major adverse events, WVTT and TIND for erectile function and PUL for ejaculatory function. Excluding WVTT and TIND, for which there were only studies with short-term (3-month) follow-up, PUL had the highest likelihood of being the most efficacious for retreatment. ConclusionsMinimally invasive treatments may result in similar or worse effects concerning urinary symptoms and quality of life compared to TURP at short-term follow-up.

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Postembolization Syndrome after Prostatic Artery Embolization: A Systematic Review

Cited by 18 publications

References 52 publications

Uterine Artery Embolisation of Fibroids and the Phenomenon of Post-Embolisation Syndrome: A Systematic Review

Uterine Artery Embolisation of Fibroids and the Phenomenon of Post-Embolisation Syndrome: A Systematic Review

Retrospective Analysis of the Effect of Lidocaine Combined with Methylprednisolone on Pain Control After Uterine Artery Embolization

Minimally invasive treatments for benign prostatic hyperplasia: a Cochrane network meta‐analysis

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