Prostate Artery Embolization for Lower Urinary Tract Symptoms in Men Unfit for Surgery

Malling, Brian; Lönn, Lars; Jensen, Rigmor; Lindh, Mats; Frevert, Susanne; Brasso, Klaus; Røder, Martin Andreas

doi:10.3390/diagnostics9020046

Cited by 19 publications

(17 citation statements)

References 37 publications

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“…The reason for this difference in discriminatory power remains speculative and could be due to patient selection, case mix, indication for surgery, or sample size, but also differences in the geriatric assessment. The lower success rate of TURP in frail patients paralleled by higher anaesthesiologic and complication risks in most series underline the role of less invasive procedures such as Rezum, UroLift, or prostate embolization in this cohort [12][13][14]. Although none of the studies with these procedures have applied a systematic geriatric assessment, the failure rates reported in patients "unfit for surgery" are not dissimilar to those after TURP in frail patients.…”

Section: Discussionmentioning

confidence: 92%

Can a Simple Geriatric Assessment Predict the Outcome of TURP?

et al. 2020

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KeywordsTURP · Geriatric · Outcome · Geriatric assessment · Benign prostatic hyperplasia · Lower urinary tract symptoms Abstract Purpose: To determine the impact of a simple preoperative geriatric assessment on the outcome in older patients with recurrent urinary retention who underwent desobstructive surgery. Patients and Methods: Patients aged 75 years or older with recurrent urinary retention referred for TURP entered this prospective, multicentre study. Several demographic, intra-and postoperative parameters were assessed. Preoperative geriatric assessment was performed by the 7-item Canadian Study of Health and Ageing (CSHA) frailty scale (1: very fit, 7: severely frail; completion takes less than a minute). The main outcome parameters were successful voiding rates at discharge and 3 months postoperatively. Results: A total of 54 patients were recruited; 42 (77.8%) patients had a CSHA index of 1-3 and were considered as "fit", the remaining 12 (22.2%) formed the "frail" group (CSHA index 4-7). Age was identical in both cohorts (79.5 ± 3.7 vs. 79.7 ± 3.3 years); differences were demonstrable for the American Society of Anesthesiologists (ASA) score (p = 0.001), the number of daily medications (> 4: 32 vs. 75%, p = 0.02), falls within the past 6 months (12 vs. 33%), and the necessity of home/nursing care (5 vs. 42%, p = 0.004). Intra-and perioperative complications, duration of postoperative catheterization, and length of hospitalization were identical in both cohorts. The success rate at discharge was 80.6% in fit and 75.0% in frail patients; the respective values at 3 months were 95.2 and 83.3%. Conclusions: A simple 1-min geriatric assessment tool can predict -to a certain extentthe outcome of desobstructive surgery in older patients with recurrent urinary retention. Fit patients achieve an excellent outcome while frail patients might benefit from a more indepth urodynamic/geriatric evaluation.

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Section: Discussionmentioning

confidence: 92%

Can a Simple Geriatric Assessment Predict the Outcome of TURP?

et al. 2020

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“…Only two patients exhibited acute urinary retention after PAE, which was relatively less common than in published studies. 9,13,26 This might have been because we extended their catheterization to 2 weeks postoperatively, which helped to reduce ischemic edema in the peri-urethral prostatic tissue after PAE. For patients with acute urinary retention after PAE, a temporary bladder catheter was routinely inserted in combination with antibiotic treatment (determined on the basis of urine culture results); decongestant medications were also administered.…”

Section: Discussionmentioning

confidence: 99%

Safety and efficacy of prostatic artery embolization for large benign prostatic hyperplasia in elderly patients

Zhang

Wang

et al. 2021

J Int Med Res

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Objective To assess the safety and efficacy of prostatic arterial embolization (PAE) for elderly patients with lower urinary tract symptoms secondary to large benign prostatic hyperplasia. Methods Twenty-eight patients (>80 years of age) with prostate volume >80 mL were enrolled from October 2016 to October 2019. PAE was performed using microspheres and functional results were evaluated at 1, 3, 6, and 12 months postoperatively. The following data were recorded: International Prostate Symptom Score (IPSS), quality of life (QoL), maximum urine flow rate (Qmax), post-void residual urine volume, prostate volume and total prostate-specific antigen level. Results Selective prostatic arterial catheterization and embolization were achieved in 27 of 28 patients. Follow-up data were available for those 27 patients until 12 months postoperatively. Significant improvements were found at all postoperative time points in terms of the mean IPSS, mean QoL score, mean Qmax, mean post-void residual urine volume, mean total prostate-specific antigen level, and mean prostate volume. The overall complication rate was 46.4%. Conclusions PAE is an efficacious and safe treatment for elderly patients with large prostate volume; it may offer an effective approach for patients who are not candidates for open or endoscopic surgical procedures because of comorbidities.

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“…This was an explorative study in a subset of patients nested within two prospective single-center trials conducted by the Department of Radiology and Urology at Rigshospitalet, Copenhagen University Hospital between March 2017 and November 2018 [16,17]. The trial was conducted in accordance with the World Medical Association Declaration of Helsinki.…”

Section: Methodsmentioning

confidence: 99%

Can Computed Tomography Perfusion Predict Treatment Response After Prostate Artery Embolization: A Feasibility Study

et al. 2020

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Prostate artery embolization (PAE) is an emerging therapy for benign prostatic hyperplasia (BPH). Optimal patient selection is an important step when introducing new treatments and several characteristics associated with a good clinical outcome has previously been proposed. However, no prognostic tool is yet available for PAE. Computed tomography perfusion is an imaging technique that provides hemodynamic parameters making it possible to estimate the prostatic blood flow (PBF). This study investigated the relationship between PBF and the response to PAE. A post hoc analysis including prostate-specific antigen (PSA) measurements before and 24-h after embolization from two prospective studies on sixteen patients undergoing PAE with BPH or prostate cancer were performed. The primary outcome was the correlation between baseline PBF and the change in PSA as a surrogate measure of treatment response. Prostate volume strongly correlated with treatment response and the response was greater with incremental amounts of injected embolic material. PBF was not associated with elevation in PSA and added no information that could guide patient selection.

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Prostate Artery Embolization for Lower Urinary Tract Symptoms in Men Unfit for Surgery

Cited by 19 publications

References 37 publications

Can a Simple Geriatric Assessment Predict the Outcome of TURP?

Can a Simple Geriatric Assessment Predict the Outcome of TURP?

Safety and efficacy of prostatic artery embolization for large benign prostatic hyperplasia in elderly patients

Can Computed Tomography Perfusion Predict Treatment Response After Prostate Artery Embolization: A Feasibility Study

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