Prostate Artery Embolization Using N-Butyl Cyanoacrylate Glue for Urinary Tract Symptoms Due to Benign Prostatic Hyperplasia: A Valid Alternative to Microparticles?

Abstract

Our goal was to evaluate the feasibility, safety, and short-term outcomes of prostate artery embolization (PAE) with N-butyl cyanoacrylate (NBCA) glue as the only embolic agent in patients with benign prostatic hyperplasia (BPH)-related lower urinary tract symptoms (LUTSs). A two-center retrospective study of 50 patients (mean age, 67.6 ± 7.4 years; range, 54–85 years) treated with NBCA between 2017 and 2020 was conducted. PAE was performed using a mixture of Glubran 2 glue and Lipiodol in a 1:8 ratio, under local anesthesia, on an outpatient basis, after cone-beam computed tomography vascular mapping. Mean total injected NBCA/Lipiodol volume was 0.9 ± 0.3 mL, total injection time was 21.9 ± 7.8 s, and total radiation dose was 18,458 ± 16,397 mGy·cm. Statistically significant improvements over time occurred for the International Prostate Symptoms Score (9.9 ± 6.8 versus 20.5 ± 6.7, p = 0.0001), quality-of-life score (2.2 ± 1.5 versus 4.9 ± 1.0, p = 0.0001), prostate-specific antigen level (4.6 ± 3.0 versus 6.4 ± 3.7, p = 0.0001), and prostate volume (77.3 ± 30.5 versus 98.3 ± 40.2, p = 0.0001) at a median of 3 months versus baseline. Minor adverse events developed in 11/50 (22%) patients, but no major complications occurred. The International Index of Erectile Function did not change significantly. PAE with NBCA is feasible, safe, fast, and effective for patients with BPH-related LUTSs. Prospective comparative studies with longer follow-ups are warranted.

X-ray Microtomography to Assess Determinants of In Vivo N-Butyl Cyanoacrylate Glubran®2 Polymerization: A Rabbit-Model Study

“…Indeed, blocked blood flow technique may be used in some situations where deep penetration of the glue embolic agent is needed for better outcomes such as tumor devascularization or prostatic artery embolization for benign prostate hyperplasia. Furthermore, BBF allows for slower and more controlled delivery of the glue in the distal vascular bed depending on the injection pressure [ 2 ]. Balloon occlusion technique during glue embolization has the same advantage in clinical practice.…”

“…A wide variety of embolic agents including metallic coils, calibrated microspheres, and liquids are available in clinical practice. The spectrum of highly prevalent health conditions for which liquid embolic agents including N-butyl cyanoacrylate (NBCA) have been proven useful is expanding steadily and now includes lower urinary-tract symptoms due to prostate enlargement, aneurysms and pseudoaneurysms, arteriovenous malformations, other vascular lesions responsible for bleeding, and solid tumors [ 2 , 3 , 4 , 5 , 6 , 7 , 8 ]. NBCA glues have been extensively studied since the late 1980s.…”

Endovascular Use of Cyanoacrylate-Lipiodol Mixture for Peripheral Embolization: Properties, Techniques, Pitfalls, and Applications

“…We demonstrated a new potential application of glue for prostate artery embolization (PAE) [ 67 ]. Indeed, PAE with NBCA is a feasible, safe, fast, and effective procedure with promising results in patients with benign prostate hypertrophy-related lower urinary tract symptoms.…”

“…Another advantage of NBCA is that the fast polymerization from surface to core avoids the opening of pre-existing vascular anastomoses, an event reported with particles, thereby potentially decreasing the risk of nontarget embolization. NBCA/Lipiodol ® has many other advantages [ 67 ]. Lipiodol ® makes the embolic material radio-opaque, allowing for easier fluoroscopic guidance as compared as with other embolic agents that are not directly visualized, such as microparticles.…”

Editorial of Special Issue “Embolization Techniques: State of the Art and Future Perspectives”

“…An innovative approach to embolization can be due to an innovative material, for example, the use of Phil in an emergency [ 18 ]. Other innovative applications are due to the use of conventional materials in unconventional districts, such as for example Onyx and Squid in abdominal diseases [ 11 , 20 ] or glue in prostate artery embolization [ 21 ], or coils in the hemorrhoidal district [ 22 ]. Another innovative approach is the association of two different embolic agents, for example coils and Squid in splenic aneurysms or gastroesophageal varices [ 9 , 23 ].…”