Protection of nontarget structures in prostatic artery embolization

Abstract

Objective: To describe the efficacy and safety of protective embolization during prostatic artery embolization, as well as to discuss its clinical relevance. Materials and Methods: This was a retrospective, observational, single-center study including 39 patients who underwent prostatic artery embolization to treat lower urinary tract symptoms related to benign prostatic hyperplasia between June 2008 and March 2018. Follow-up evaluations, performed at 3 and 12 months after the procedure, included determination of the International Prostate Symptom Score, a quality of life score, and prostate-specific antigen levels, as well as ultrasound, magnetic resonance imaging, and uroflowmetry. Results: Protective embolization was performed in 45 arteries: in the middle rectal artery in 19 (42.2%); in the accessory internal pudendal artery in 11 (24.4%); in an internal pudendal artery anastomosis in 10 (22.2%); in the superior vesical artery in four (8.9%); and in the obturator artery in one (2.2%). There was one case of nontarget embolization leading to a penile ulcer, which was attributed to reflux of microspheres to an unprotected artery. There were no complications related to the protected branches. All of the patients showed significant improvement in all of the outcomes studied (p < 0.05), and none reported worsening of sexual function during follow-up. Conclusion: Protective embolization can reduce nontarget embolization during prostatic artery embolization without affecting the results of the procedure. In addition, no adverse events other than those expected or previously reported were observed. Therefore, protective embolization of pudendal region is safe.

Prostatic Artery Embolization: Technical Pearls

“…High-flow collaterals to these regions, such as those arising from the IPA, middle rectal artery, and superior rectal artery, are at higher risk of facilitating NTE. 13 Due to this distribution, NTE may lead to rectal and bladder ischemia or penile ulcers. 17 Using preoperative CTA or intraprocedural CBCT can significantly increase the identification rates of such collaterals and decrease the risk of NTE.…”

“…12 Extraprostatic anastomoses are found in 39.1% of hemipelves, most commonly with the IPA, middle rectal artery, and SVA. 9 13 NTE can occur because of reflux into or inadvertent embolic delivery to the communications to penile, vesical, or rectal vasculature. Therefore, identifying and adequately handling these anastomoses are essential to prevent NTE.…”

“…High-flow collaterals to these regions, such as those arising from the IPA, middle rectal artery, and superior rectal artery, are at higher risk of facilitating NTE. 13 Due to this distribution, NTE may lead to rectal and bladder ischemia or penile ulcers. 17…”