Prostate artery embolization has long term efficacy for treatment of severe lower urinary tract symptoms from giant prostatic hyperplasia

Abstract

Background Patients with severe lower urinary tract symptoms (LUTS) from giant prostatic hyperplasia (GPH): prostate volume greater 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 investigation examined the long-term efficacy and safety of prostatic arterial embolization (PAE) as a treatment option for severe LUTS due to GPH in a large patient cohort. Methods Of 529 patients who underwent PAE between January 2016 and January 2020, 72 patients had severe LUTS from GPH and were retrospectively evaluated. PAE was performed with two embolic agents in sequence: 100–250 μm particles followed by 2 mm and 3 mm coils. Clinical assessment was performed with international prostate symptoms score (IPSS), quality of life (QoL), peak flow rate (Qmax), post-void residual volume (PVR), and prostate specific antigen (PSA) measurements before and 12 months and 24 months after PAE. Prostate volume (PV) was measured by multiparametric magnetic resonance (MR) imaging before and 12 months and 24 months after PAE. Results Patients with severe LUTS from GPH experienced significant clinical improvements in IPSS, QoL, Qmax, PVR, PSA, and PV at 12 months and 24 months after PAE. Mean IPSS decreased from 26.5 to 18.0 (P < 0.01) to 10.5 (P < 0.01). Mean QoL decreased from 6.0 to 4.0 (P < 0.01) to 2.0 (P < 0.01). Mean Qmax increased from 8.0 to 14 mL/s (P < 0.01) to 18 mL/s (P < 0.01). Mean PVR decreased from 198.0 to 152.0 mL (P < 0.01) to 90 mL (P < 0.01). Mean PV decreased from 303.0 mL to 258.0 mL (P < 0.01) to 209.0 mL (P < 0.01). Mean PSA decreased from 11.2 ng/mL to 9.5 ng/mL (P < 0.05) to 7.9 ng/mL (P < 0.05). No major complications occurred. Conclusions PAE is a safe treatment with long term efficacy for severe LUTS from 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.

Comparative efficacy and safety of prostatic urethral lift vs prostatic artery embolization for benign prostatic hyperplasia: a systematic review and network meta‐analysis

“…In cases of patients with large prostates, enucleation procedures such as holmium laser enucleation of the prostate should be considered as an alternative to TURP or open prostatectomy, although laser enucleation procedures have the main drawback of a long learning curve and require specific endourological equipment which is not available in all institutions [6,31,32]. However, PAE has been reported to be a safe and efficacious treatment in patients with prostate volumes of up to 100 mL or larger [33,34]. However, PAE has been reported to be a safe and effective treatment in patients with prostate volumes of up to 100 mL or larger that can be performed under local anaesthesia in patients with associated cardioulmonary comorbidities; therefore, PAE might be reserved for those patients with larger prostates and those not suitable for procedures requiring general anaesthesia such as TURP or enucleation techniques [31].…”

Prostate Artery Embolization—Review of Indications, Patient Selection, Techniques and Results

“…However, the large prostate size group had significantly better outcomes compared to the medium prostate group with regards to IPSS, maximum flow rate (Q max ), PV and PVR. Several authors consider PAE to be better suited for larger prostates (>80 g) as it may be more technically amenable to embolization and more likely to have favorable results compared to smaller prostates (<50 g) [ 28 , 47 , 48 ]. Other studies have shown little correlation with prostate size and clinical outcome; one retrospective study evaluated prostate size prior to PAE in order to determine its impact on IPSS score.…”

Prostate Artery Embolization for Megaprostate Causing Urinary Retention, DVT and Macroscopic Haematuria Post Thrombolysis and Catheterisation: A Case Report

“…Open simple prostatectomy and novel endoscopic holmium laser enucleation (HoLEP) is the recommendation for glands >100cc [4]. Simple open prostatectomy is associated with signi cant morbidity in this setting, including peri-operative blood loss requiring transfusion (8-15%), urinary incontinence (10%) and urinary bladder neck stenosis or urethral strictures (5%) [6,7].…”

“…Giant prostatic hyperplasia (GPH), also known as megaprostate, has been de ned as BPH prostatomegaly with gland volume greater than 200cc [7]. Previously, GPH was de ned as gland weight over 500g post resection [8].…”

“…Previously, GPH was de ned as gland weight over 500g post resection [8]. Megaprostates are uncommon, representing 4% of all BPH and typically present in the 7th decade [7,9]. In addition to LUTS, GPH can present with macroscopic haematuria and exert mass effect on adjacent pelvic structures.…”