Prostatic arterial embolization for the treatment of lower urinary tract symptoms caused by benign prostatic hyperplasia: a comparative study of medium‐ and large‐volume prostates

Abstract

ObjectivesTo compare the outcomes of prostatic arterial embolization (PAE) in treating large (>80 mL) in comparison with medium-sized prostate glands (50-80 mL) to determine whether size affects the outcome of PAE. Patients and MethodsA total of 115 patients (mean age 71.5 years) diagnosed with lower urinary tract symptoms (LUTS) attributable to benign prostatic hyperplasia (BPH) refractory to medical treatment underwent PAE. Group A (n = 64) included patients with a mean prostate volume of 129 mL; group B (n = 51) included patients with a mean prostate volume of 64 mL. PAE was performed using 100-lm particles. Follow-up was performed using the International Prostate Symptom Score (IPSS), quality of life (QoL), peak urinary flow rate (Q max ), post-void residual urine volume (PVR), the International Index of Erectile Function short form (IIEF-5), prostate-specific antigen (PSA) and prostate volume measured by magnetic resonance imaging at 1, 3 and 6 months, and every 6 months thereafter. ResultsThere were no significant differences between groups in baseline IPSS, QoL, Q max , PVR, PSA level or IIEF-5 score.The technical success rate was 93.8% in group A and 96.8% in group B (P = 0.7). A total of 101 patients (55 patients in group A and 46 patients in group B) completed the mean (range) follow-up of 17 (12-33) months. Compared with baseline, there were significant improvements in IPSS, QoL, Q max , prostate volume and PVR in both groups after PAE. The outcomes in group A were significantly better than in group B with regard to mean AE SD IPSS (À14 AE 6.5 vs À10.5 AE 5.5, respectively), Q max (6.0 AE 1.5 vs 4.5 AE 1.0 mL/s, respectively), PVR (À80.0 AE 25.0 vs À60.0 AE 20.0 mL, respectively), prostate volume (À54.5 AE 18.0 mL [À42.3%] vs À18.5 AE 5.0 mL [À28.9%], respectively), and QoL score (À3.0 AE 1.5 vs À2.0 AE 1.0) with P values <0.05. The mean IIEF-5 score was not significantly different from baseline in both groups. No major complications were noted. ConclusionsWe found that PAE is a safe and effective treatment method for patients with LUTS attributable to BPH. The clinical and imaging outcomes of PAE were better in patients with larger prostate glands than medium-sized ones.

Current Status of Prostate Artery Embolization for Lower Urinary Tract Symptoms: Review of World Literature

“…A minimum of 10 patients in the sample size was applied as inclusion criteria. In total, 7 trials on PAE for LUTS were identified having fully published their findings [3,4,5,6,7,8,9].…”

“…Most recently, Wang et al published findings comparing outcomes of PAE in the treatment of large sized prostates (>80ml) versus medium sized prostates (50-80ml) [9]. Their results revealed a significantly greater improvement in IPSS, QoL, Qmax, PVR and PV in the group with large sized prostates.…”

“…Based on the 2013 EAU guidelines, the rate of complications rises with increased gland size and therefore the upper limit for TURP is mostly suggested at 80ml with the caveat that this value will vary with surgeon experience [30]. Evidence from short term data on PAE suggests that this evolving technology can be used for large cases with no additional risk of adverse events [9]. For many patients undergoing PAE, catheterization of the bladder is not needed at all and their medication for BPH can be discontinued post procedure.…”

Benign Prostat Hiperplazisinde Prostatik Arter Embolizasyonu

“…), büyük mesane taşı, kronik böbrek yetmezliği, aktif üriner enfeksiyon ve düzeltilemeyen koagülo-pati PAE için kontraendikedir [32,33]. Transüretral prostat rezeksiyonunun (TURP) aksine PAE'da prostat hacmi için bir üst sınır olmayıp literatürdeki kısa ve orta dönem çalışmalar bü-yük hacimli prostatların (>80cm 3 ) PAE sonrası ek komplikasyon riski oluşturmadığını göster-miştir [29,[34][35][36].…”

Estudo comparativo entre microesferas de 100-300um e 300-500um utlizadas na embolização das artérias prostáticas para o tratamento dos sintomas urinários decorrentes da hiperplasia prostática benigna

“…Wang et al 59 , na tentativa de comparar o resultado da EAP em próstatas de diferentes dimensões, utilizaram também partículas não esféricas de PVA com diâmetro de 47-90 µm, após cateterismo superseletivo distal das artérias prostáticas, obtendo estase parcial. Depois realizavam oclusão do respectivo vaso proximalmente com partículas pouco maiores (90 a 180 µm) até estase completa, com sucesso técnico e clínico.…”