3:56 PM Abstract No. 10 Coil embolization of penile arterial collaterals during PAE efficacy and safety profile

Abstract

Purpose: To determine a single-center experience of sexual functionality, symptomatology, benefits and complications after coil embolization of arterial collaterals supplying blood to the penile plexus as an adjunct during prostatic artery embolization (PAE). Materials: A retrospective analysis of patients who underwent PAE with coil embolization (cPAE) of arterial communications to the penile vascular plexus to prevent nontarget embolization between September 2014 and September 2017. Clinical symptomatology data (IIEF/SHIM, QOL, Qmax, PVR, and nocturia) and medication usage was collected pre-procedure and at follow-up clinic visits (1 month, 3 months, 6 months, and 1 year). Adverse events, identified in accordance with the SIR guidelines, were collected during follow-up. Results: 29 patients underwent cPAE with coils placed in a capsular artery to penile plexus communication (n ¼ 16), prostatic artery to penile plexus communication (n ¼ 6), accessory pudendal artery (APA) to penile plexus communication (n ¼ 5), obturator artery to distal prostatic artery branch (n ¼ 1), and prostatic artery communication to contralateral APA (n ¼ 1) to prevent nontarget distal embolization to the penis. The average IIEF/SHIM score increased by 1.23 points (14.18 to 15.41, p ¼ 0.51), reported episodes of nocturia decreased by 1.375 events per night (3.5 to 2.125, p ¼ 0.007), and average QOL improved by 4.25 points (5 to 0.75, p ¼ 0.00008) at the most recent clinic visits, while the average Qmax improved by 4.67cc/s (8.77cc/s to 13.4cc/s, p ¼ 0.018), and PVR decreased by 11.72cc (108.12cc to 96.4cc, p ¼ 0.73) over a 1 year interval. Two major complications occurred: urosepsis (3.4%) resolved after a week of intravenous antibiotics, and glans penis ischemia (3.4%) after an arterial collateral became visualized post injection of embolic material. The most common minor complication, dysuria, occurred in 12/29 patients (41%). Conclusions: Coil embolization of arterial communications with the penile plexus during prostatic artery embolization appears to be a safe adjunctive technique in preventing nontarget embolization and sexual side effects do not appear to be a major concern.