Background
Patients with severe lower urinary tract symptoms (LUTS) from giant prostatic hyperplasia (GPH): prostate volume larger than 200 mL that do not respond to medical therapy may not be eligible for surgical treatments due to morbidities, technical challenges, and patient preference. This retrospective study examined the safety and long-term efficacy of prostatic arterial embolization (PAE) as a treatment option for severe LUTS due to GPH in a large cohort of patients.
Methods
72 patients with GPH and severe LUTS who underwent PAE were retrospectively evaluated. PAE was performed bilaterally with two embolic agents in sequence: 100 µm to 250 µm embolic particles followed by 2 mm and 3 mm coils. Clinical assessment was performed by collecting international prostate symptoms score (IPSS), quality of life (QoL), and post-void residual volume (PVR) before PAE and 12 months and 24 months after PAE. Prostate volume (PV) was measured by multiparametric magnetic resonance (MR) imaging before PAE and 12 months and 24 months after PAE.
Results
Patients with severe LUTS from GPH experienced significant clinical improvements in IPSS, QoL, PVR, and PV at 12 months and 24 months after PAE. Mean IPSS decreased from 26.5 to 18.0 (P < .0.01) at 12 months and to 10.5 (P < .0.01) at 24 months. Mean QoL decreased from 6.0 to 4.0 (P < 0.01) at 12 months and to 2.0 (P < 0.01) at 24 months. Mean PVR decreased from 198.0 mL to 152.0 mL (P < 0.01) at 12 months and to 90 mL (P < 0.01) at 24 months. Mean PV decreased from 303.0 mL to 258.0 mL (P < 0.01) at 12 months and to 209.0 mL (P < 0.01) at 24 months. There were no major complications.
Conclusions
PAE is a safe treatment option with long term efficacy in patients with severe LUTS due to GPH. PAE may be a viable therapeutic option for patients with severe LUTS from GPH whom fail medical therapy and are not candidates for surgical treatments.