Prostatic Arterial Embolization with Small Sized Particles for the Treatment of Lower Urinary Tract Symptoms Due to Large Benign Prostatic Hyperplasia

Abstract

Background:The clinical failure after prostatic artery embolization (PAE) with conventional particles was relatively high, in treatment for lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH). We reported the results of PAE with combined polyvinyl alcohol particles 50 μm and 100 μm in size as a primary treatment in 24 patients with severe LUTS secondary to large BPH.Methods:From July 2012 to June 2014, we performed PAE in 24 patients (65–85 years, mean 74.5 years) with severe LUTS due to large BPH (≥80 cm3) and refractory to medical therapy. Embolization was performed using combination of 50 μm and 100 μm in particles size. Clinical follow-up was performed using the International Prostate Symptom Score (IPSS), quality of life (QoL), peak urinary flow (Qmax), postvoid residual (PVR) volume, the International Index of Erectile Function (IIEF), prostatic specific antigen (PSA), and prostatic volume measured by magnetic resonance imaging at 1, 3, 6, and every 6-month thereafter. Technical success was defined when PAE was completed in at least one pelvic side. Clinical success was defined as the improvement of both symptoms and QoL. A Student's t-test for paired samples was used.Results:PAE was technically successful in 22 patients (92%). Bilateral PAE was performed in 19 (86%) patients and unilateral in 3 (14%) patients. Follow-up data were available for 22 patients observed for mean of 14 months. The clinical improvement at 1, 3, 6, and 12-month was 91%, 91%, 88%, and 83%, respectively. At 6-month follow-up, the mean IPSS, QoL, PVR, and Qmax were from 27 to 8 (P = 0.001), from 4.5 to 2.0 (P = 0.002), from 140.0 ml to 55.0 ml (P = 0.002), and from 6.0 ml/s to 13.0 ml/s (P = 0.001), respectively. The mean prostate volume decreased from 110 cm3 to 67.0 cm3 (mean reduction of 39.1%; P = 0.001). The PSA and IIEF improvements after PAE did not differ from pre-PAE significantly. No major adverse events were noted.Conclusions:The combination of 50 μm and 100 μm particles for PAE is a safe and effective treatment method for patients with severe LUTS due to large BPH, which further improves the clinical results of PAE.

Medium- and Long-Term Outcome of Prostate Artery Embolization for Patients with Benign Prostatic Hyperplasia: Results in 630 Patients

“…PAE was performed using 100 mm and/or 200 mm nonspherical PVA particles (Cook, Inc) in 418 patients, 300-500 mm spherical PVA particles (Bead Block; Biocompatibles UK Ltd, London, United Kingdom) in 167 patients, and 400 mm Polyzene-coated hydrogel microspheres (Embozene; CeloNova BioSciences, Inc, San Antonio, Texas) in 33 patients (15,24,27). The embolization endpoint selected was occlusion of the arterial branches supplying the prostate, prostate gland opacification, and reflux toward the origin of the prostatic artery or the anterior division of the internal iliac artery.…”

“…PAE is a minimally invasive therapy that has been shown to be safe and effective for LUTS associated with BPH, resulting in good short-term and medium-term outcomes, a decrease in prostate volume (PV), and significant clinical improvement (10)(11)(12)(13)(14)(15). Nonspherical polyvinyl alcohol (PVA) particles have been the most commonly used embolic agent for PAE (14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28). The aim of this retrospective cohort study was to confirm that PAE has a positive effect on all objective outcomes in symptomatic BPH between 2 and 6.5 years of follow-up.…”

Efficacy and safety of prostate artery embolization on lower urinary tract symptoms related to benign prostatic hyperplasia: a systematic review and meta-analysis

“… Note: Data from Isaacson et al,9 Bagla et al,10 Li et al,11 and Wang et al12 Abbreviations: BPH, benign prostatic hyperplasia; CI, confidence interval; IIEF-5, International Index of Erectile Function; IPSS, International Prostate Symptom Score; MD, mean difference; PAE, prostate artery embolization; PSA, prostate-specific antigen; PV, prostate volume; PVR, postvoid residual; Q max , peak urinary flow rate; QoL, quality of life.…”

State of the art of prostatic arterial embolization for benign prostatic hyperplasia

“…All studies included only symptomatic patients presenting moderate or severe LUTS (12,(20)(21)(22)(23)(24). Some of them (12,21,23,24), also specified the required grade of LUTS in terms of IPSS: Li defined a threshold score of 12 (23), while Bilhim, Pisco and Wang demanded an IPSS higher than 18, therefore involving only patients with severe LUTS (12,21,24). In addition, most of these studies were designed to comprise only patients who were not responsive to medical treatment for at least 6 months (12,21,22).…”

“…In addition, most of these studies were designed to comprise only patients who were not responsive to medical treatment for at least 6 months (12,21,22). Further criteria of eligibility were: QoL score >3 (12,21,22) Qmax ≤12 or <15 mL/s (23), PSA <4 ng/mL (23) and sexual dysfunction (12). Notably, no age restrictions were mentioned in any of the published studies (12,(20)(21)(22)(23)(24).…”