Prostatic Artery Embolization Using Reflux-control Microcatheter: Prospective Experience Addressing Feasibility.

Abstract

Purpose: To describe the initial experience regarding efficacy and safety of Prostatic Artery Embolization (PAE) using a reflux control microcatheter. Materials and methods: This is a prospective, single-center investigation that included 10 patients undergoing PAE for treatment of lower urinary tract symptoms (LUTS) attributed to benign prostate hyperplasia (BPH). Baseline, 3-month and 12-month efficacy endpoints were obtained for all patients, and included prostate-specific antigen (PSA), uroflowmetry, pelvic magnetic resonance imaging (MRI) and clinical assessment using the International Prostate Symptom Score (IPSS) questionnaire and the IPSS-Quality of life (QoL) item. Complications were assessed using the Cirse classification system. Results: Ten patients entered statistical analysis and presented with significant LUTS improvement 12 months after PAE, as follows: mean IPSS reduction of 86.6% (2.8 vs. 20.7, -17.9, P < 0.001), mean QoL reduction of 79.4% (1.1 vs. 5.4, -4.3, P < 0.001), mean prostatic volume reduction of 38.4% (69.3 cm3 vs. 112.5 cm3, - 43.2 cm3, P < 0.001), mean peak urinary flow (Qmax) increase of 199.4% (19.9 mL/s vs. 6.6 mL/s, +13.3 mL/s, P = 0.006) and mean PSA reduction of 50.1% (3.0 ng/mL vs. 6.1 ng/mL, -3.0 ng/mL, P < 0.001). One patient (10%) needed transurethral resection of the prostate (TURP) after PAE due to a ball-valve effect. One patient (10%) needed coil protective embolization of a high flow intraprostatic anastomosis. One microcatether (10%) needed to be replaced during PAE due to occlusion. Non-target embolization was not observed in the cohort.Conclusion: This initial experience suggests that PAE using a reflux control microcatheter is effective and safe for the treatment of LUTS attributed to BPH. High flow intraprostatic anastomosis still need coil protective embolization to avoid NTE even with the use of reflux-control microcatheters.