Prostatic Arterial Embolization to Treat Benign Prostatic Hyperplasia

Abstract

PURPOSE:To evaluate whether prostatic arterial embolization (PAE) might be a feasible procedure to treat lower urinary tract symptoms associated with benign prostatic hyperplasia (BPH). MATERIALS AND METHODS:Fifteen patients (age range, 62-82 years; mean age, 74.1 y) with symptomatic BPH after failure of medical treatment were selected for PAE with nonspherical 200-m polyvinyl alcohol particles. The procedure was performed by a single femoral approach. Technical success was considered when selective prostatic arterial catheterization and embolization was achieved on at least one pelvic side. RESULTS:PAE was technically successful in 14 of the 15 patients (93.3%). There was a mean follow-up of 7.9 months (range, 3-12 months). International Prostate Symptom Score decreased a mean of 6.5 points (P ϭ .005), quality of life improved 1.14 points (P ϭ .065), International Index of Erectile Function increased 1.7 points (P ϭ .063), and peak urinary flow increased 3.85 mL/sec (P ϭ .015). There was a mean prostate-specific antigen reduction of 2.27 ng/mL (P ϭ .072) and a mean prostate volume decrease of 26.5 mL (P ϭ .0001) by ultrasound and 28.9 mL (P ϭ .008) by magnetic resonance imaging. There was one major complication (a 1.5-cm 2 ischemic area of the bladder wall) and four clinical failures (28.6%). CONCLUSIONS:In this small group of patients, PAE was a feasible procedure, with preliminary results and short-term follow-up suggesting good symptom control without sexual dysfunction in suitable candidates, associated with a reduction in prostate volume. ABBREVIATIONSBPH ϭ benign prostatic hyperplasia, IPSS ϭ international prostate symptom score, PAE ϭ prostatic arterial embolization, PSA ϭ prostate specific antigen, PVA ϭ polyvinyl alcohol, PVR ϭ postvoid residual volume, Q max ϭ peak urinary flow, QOL ϭ quality of life Benign prostatic hyperplasia (BPH) has a high prevalence rate in men aged 50 -79 years (1) and is ubiquitous with aging (2). BPH is a condition often associated with lower urinary tract symptoms (3), the most frequent of which are decreased urinary stream, greater frequency, and urgency (4).Surgery is performed less often now that effective pharmacotherapy is available, but it is an excellent option for improving symptoms and decreasing progression of disease in patients who develop complications or whose symptoms are inadequately controlled with medical treatment (5).Prostatectomy by open surgery or by transurethral resection of the prostate is still considered the gold standard of treatment. Alternative options include minimally invasive treatments and prostatic stent placement. Age, symptom scores, grade of obstruction, baseline prostate volume, peak urinary flow (Q max ), serum prostate specific antigen (PSA) value, and postvoid residual volume (PVR) are important predictors of clinical progression (6) and, along with individual anesthesiologist risk, are factors that should be taken into consideration when choosing an appropriate treatment (7).Urinary tract infection, strictures, postoperati...

Unilateral Versus Bilateral Prostatic Arterial Embolization for Lower Urinary Tract Symptoms in Patients with Prostate Enlargement

“…PAE is considered technically challenging and unilateral PAE has been reported in all of these preliminary studies [2][3][4]. In the present study, 15.6 % of patients underwent unilateral embolization due to significant atherosclerotic lesions and tortuosity of the iliac and prostatic arteries.…”

“…Our procedure protocol has been described previously [3]. We asked patients to stop all prostatic medication 1 week before embolization, if they were able to tolerate it.…”

“…Both patients had significant clinical relief. Another series [3] showed that unilateral PAE might lead to moderate clinical relief with 8 % prostate volume reduction and 18 % reduction in PSA. However, the preliminary case report described a patient who underwent unilateral PAE with 38 % prostate volume reduction, 90 % decrease in PSA, and significant clinical relief [1].…”

“…Keywords Prostatic arterial embolization Á Unilateral Á Benign prostatic hyperplasia Á Lower urinary tract symptoms Preliminary studies have shown that prostatic arterial embolization (PAE) for the relief of lower urinary tract symptoms (LUTS) in patients with prostate enlargement/ benign prostatic hyperplasia (PE/BPH) is a promising, new, minimally invasive, image-guided therapy [1][2][3][4]. However, PAE is a technically challenging procedure with unilateral embolization and technical failure reported rates of approximately 10-15 and 7 %, respectively [1][2][3][4].…”

“…However, PAE is a technically challenging procedure with unilateral embolization and technical failure reported rates of approximately 10-15 and 7 %, respectively [1][2][3][4]. To perform the procedure in a safe manner without nontarget embolization to periprostatic tissues, precise knowledge of the male pelvic and PA anatomy and imaging findings is required [5][6][7].…”