Adjunctive Coil Embolization of the Prostatic Arteries After Particle Embolization for Prostatic Artery Embolization

Galla, Naveen; Maron, Samuel Z.; Voutsinas, Nicholas; Sher, Alex; Tangel, Matthew; Jue, Joshua S.; Sharma, Himanshu; Lookstein, R.; Fischman, A.; Rastinehad, Ardeshir R.

doi:10.1007/s00270-021-02964-5

Cited by 9 publications

(4 citation statements)

References 10 publications

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“…59 A handful of studies have attempted to utilize different particles or coil after embolization to make prostatic occlusion more permanent, and longer-term follow-up is pending. 60 In this study, Galla et al did note that distal catheterization to densely packed detachable coils was feasible in one patient who required repeat PAE because the coil was nonocclusive. However, short-term urodynamic, IPSS, and QoL improvement were in line with reports where no adjunctive coil embolization is used.…”

Section: Controversy No 4: Retreatment Rates Depict a False Narrative...mentioning

confidence: 69%

Controversies in Prostate Artery Embolization: Future Best Practice

Goyal

Salem

Mouli

2022

Semin intervent Radiol

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Prevalence of lower urinary tract symptoms secondary to benign prostatic hyperplasia is correlated with age. Men seeking treatment options with a low side effect profile often turn to prostate artery embolization (PAE). PAE continues to be refined with advanced tools and optimized techniques. Nonetheless, there exist controversies in terms of best practices for the management of lower urinary track symptoms (LUTS) with PAE. These controversies are essential for medical progress. Herein we suggest best practices moving forward based on currently available data. Given extensive safety data, we recommend PAE be considered alongside medical management and as a precursor to surgery. Given demonstrated efficacy across gland sizes, PAE can be performed in a single session, ideally in a hybrid angio-CT suite, without preoperative cross-sectional imaging. PAE should be initially performed with 300- to 500-μm size particles, and instead consider exploring other particles and sizes for repeat PAE. Finally, PAE can also be considered as first-line option for recurrent disease given the efficacy and excellent safety profile. This article is not meant to purport a dogma, but rather to serve as a guide to the experienced practitioner in challenging his or her own biases when performing PAE.

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Section: Controversy No 4: Retreatment Rates Depict a False Narrative...mentioning

confidence: 69%

Controversies in Prostate Artery Embolization: Future Best Practice

Goyal

Salem

Mouli

2022

Semin intervent Radiol

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“…In the recent years, some technical modifications of the original PAE have been developed in an attempt to improve its effectiveness and safety in patients, such as the PErFecTED technique (Proximal Embolization First, Then Embolize Distal) which led to greater infarcts in prostates attributable to a better distribution and delivery of embolic agent in the targeted prostatic arteries ( 17 ); but no significant difference regarding PV reduction was found between both techniques ( 18 ). The use of coil as adjunctive treatment in PAE has been also developed with aiming to increase the effectiveness in PAE delivering a coil into the main prostatic arteries after PAE ( 19 ); and its safety occluding anastomosis between the prostatic artery and adjacent organs (bladder, penis or rectum) avoiding non-target embolization during the particle embolization ( 20 ). Even liquid embolic agent (glue) has been described in PAE without significant differences in International Prostate Symptoms Score, quality of life and PV compared with microparticles in patients ( 21 , 22 ).…”

Section: Discussionmentioning

confidence: 99%

Prostatic artery occlusion: initial findings on pathophysiological response in a canine prostate model

Lucas‐Cava¹,

Sánchez‐Margallo²,

Moreno-Lobato³

et al. 2022

Transl Androl Urol

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Background: Prostatic artery embolization (PAE) is an alternative treatment for symptomatic benign prostatic hyperplasia (BPH) in men. A technical modification of conventional PAE has been developed in a canine prostate model consisting of prostatic artery occlusion (PAO) using Onyx ® whose therapeutic effect is prostate shrinkage. However, the underlying mechanisms are not well clarified. The purpose was to evaluate the biological mechanisms responsible for therapeutic effects of PAO in the canine prostate.Methods: Ten adult male beagles (5.0±0.82 years) underwent PAO with Onyx-18 (n=7) and prostatic artery angiography as control (n=3). Blood samples were taken at different time points of follow-up (baseline, 1 week, 2 weeks, 1 month, 3 months and 6 months) to measure the serum canine prostate specific esterase (CPSE). MRI examinations were also performed to document the prostate volume (PV) before and after interventions at different time points of follow-up. Prostates were harvested at 2 weeks (n=2) in the PAOgroup, and the remaining ones (n=8) at 6 months for the determinations of intraprostatic testosterone and dihydrotestosterone (DHT) by ELISA, apoptosis by TUNEL assay and histopathological study. Results:The mean serum CPSE concentration started to decrease significantly from 2 weeks to 6 months after PAO along with PV compared with baseline data. In addition, a moderate but significant correlation was observed between CPSE and PV (r=0.655, P=0.000). Regarding intraprostatic androgens, testosterone was significantly higher after PAO than control (19.70 vs. 4.87 ng/mL, P=0.002), whereas DHT was lower but no significant (112.52 vs. 138.35 pg/mL, P=0.144). In histological study, PAO induced a severe hemorrhagic necrosis in the whole prostates along with inflammatory cell infiltration at early 2 weeks, and then diffuse interstitial fibrosis with atrophy of the glandular epithelium and intraprostatic cavity formation at 6 months.Apoptosis was detected in all specimens with higher apoptotic index after PAO at 2 weeks (7.35%) and at 6 months (4.38%) compared with control (2.64%), without statistically significant difference between groups.

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“…24 25 Coil embolization as an adjunct embolic agent has recently been reported as technically feasible with no adverse events. 26…”

Section: Discussionmentioning

confidence: 99%

Prostate Artery Embolization in Patients above Eighty Years Old: Clinical Efficacy and Safety

Saro

Solyman

Zaki

et al. 2022

The Arab Journal of Interventional Radiology

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Purpose Prostate artery embolization (PAE) has been established as an effective treatment option for benign prostate hyperplasia or hematuria of prostatic origin. We aim to confirm the effectiveness and safety of PAE in elderly patients aged ≥ 80 years old. Materials and Methods Between January 2014 and August 2020, PAE was attempted on 54 elderly patients with lower urinary tract symptoms (LUTS) or prostatic hematuria who were unfit for surgical treatment or opted for PAE. Outcome parameters (International Prostate Symptom Score [IPSS], quality of life [QoL] score, International Index of Erectile Function score (IIEF), maximal urinary flow rate, postvoid residual, and prostate volume) were collected and analyzed at baseline, 6 months, 1, 2, and 3 years. Results The mean patient age was 85.29 years (range: 80–98). Technical success was achieved in 50 patients (92.6%). Mean IPSS improved from 18 at baseline to 7.7, 8.5, 8.6, and 9.1 at 6 months, 1, 2, and 3 years. Mean QoL improved from 4.9 at baseline to 2.8, 1.7, and 1.5 at 6 months, 1, and 2 years. Mean prostate volume reduced from a baseline of 152.7 to 123.5 mL within 6 months and 120.5 mL after 7 months of PAE. Urinary catheter removal was successful in 13 out of 19 patients with urinary retention. PAE succeeded in stopping bleeding in 16 out of 17 patients with prostate-induced hematuria. Conclusion PAE is a feasible low-risk treatment for LUTS with or without urinary retention or prostatic hematuria in elderly patients.

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Adjunctive Coil Embolization of the Prostatic Arteries After Particle Embolization for Prostatic Artery Embolization

Cited by 9 publications

References 10 publications

Controversies in Prostate Artery Embolization: Future Best Practice

Controversies in Prostate Artery Embolization: Future Best Practice

Prostatic artery occlusion: initial findings on pathophysiological response in a canine prostate model

Prostate Artery Embolization in Patients above Eighty Years Old: Clinical Efficacy and Safety

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