Prostatic artery embolization (PAE) in catheter-dependent patients with large prostatic (BPH) glands (>90 cc): early intervention essential

Abstract

Background Prostate artery embolization (PAE) is safe and effective at improving lower urinary tract symptoms (LUTS) in men with benign prostatic hyperplasia (BPH). Purpose To assess the effectiveness of PAE on allowing successful voiding in patients with obstructive BPH (>90 cc) necessitating a urethral catheter for complete urinary retention. Material and Methods Ten consecutive patients with urethral catheters for obstructing BPH were included in the prospective study. Prostate arteries were embolized (Embosphere 300–500 um) and they had an attempted trial without catheter (TWOC) at two weeks and then at two-week intervals thereafter, if unsuccessful. They were clinically reviewed; an MRI was performed three and 12 months after PAE. Quality of life (QOL) questionnaires, International Prostate Symptom Score (IPSS), and International Index of Erectile Function (IIEF) were also performed. Results All cases were technically successful (100%). Eight patients had their catheters removed by their three-month follow-up (80%). The two cases that failed their TWOC by three months remained with a urethral catheter at 12-month follow-up. Seven of ten patients had their PAE procedure < 3 months following insertion of the urethral catheter and 100% of these had a successful TWOC before their three-month follow-up. Of the three patients that had their urethral catheter inserted > 3 months before their PAE (range 6–24 months), only 1/3 (33%) became catheter-free by 12 months after PAE. There was a dramatic reduction in LUTS and improvements in QOL indices, IPSS, and IIEF. There was no associated sexual dysfunction. Conclusion PAE is very successful in allowing spontaneous voiding in men with obstructing BPH requiring a urethral catheter. However, the PAE should be performed as soon as possible after the urethral catheter is inserted. Direct referral from acute urology services or emergency departments once the catheter is inserted are warranted.

Safety and efficacy of prostatic artery embolization for large benign prostatic hyperplasia in elderly patients

“…Consistent with the findings of previous investigations, 6,12–14 our study showed that PAE is an efficacious treatment for LUTS secondary to large prostate volume (>80 mL) in elderly patients (≥80 years of age) who were not suitable candidates for open or endoscopic surgical procedures; notably, we found that this surgical approach had a favorable safety profile. All six of the monitored functional results were significantly improved at 12 months postoperatively in the present study, similar to the results reported by Gao et al.…”

“…PAE was proposed relatively recently and has been the focus of increasing interest in both radiological and urological communities since its first successful use for BPH with acute urinary retention in 2010. 7 Consistent with the findings of previous investigations, 6,[12][13][14] our study showed that PAE is an efficacious treatment for LUTS secondary to large prostate volume (>80 mL) in elderly patients (!80 years of age) who were not suitable candidates for open or endoscopic surgical procedures; notably, we found that this surgical approach had a favorable safety profile. All six of the monitored functional results were significantly improved at 12 months postoperatively in the present study, similar to the results reported by Gao et al 9 Furthermore, Lebdai et al 15 reported a mean reduction in IPSS of 11.9 points at 1 month postoperatively, which persisted at 6 months postoperatively.…”

Prostate Artery Embolization—Review of Indications, Patient Selection, Techniques and Results

“…Catheter removal was achieved in 33 (81%) of patients [ 22 ]. In another study, similar results were found, with 80% of catheter-dependent becoming catheter-free 3 months after undergoing PAE [ 23 ]. Comparable results were found in another study showing 33 out of 38 (87%) of catheter-dependent patients capable of being catheter-free after 3 months [ 19 ].…”