Prostatic arterial supply: demonstration by multirow detector Angio CT and Catheter Angiography

Bilhim, Tiago; Pisco, João Martins; Furtado, Andrea; Casal, Diogo; Pais, Diogo; Pinheiro, Luís Campos; O’Neill, João Goyri

doi:10.1007/s00330-010-2015-0

Cited by 76 publications

(45 citation statements)

References 10 publications

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“…Uroflowmetry measuring the maximum flow rate (Qmax) and the postvoid residual volume (PVR) was performed in all patients who were not experiencing AUR. Pre-procedural sectional imaging planning with CT angiography (CTA) to evaluate the feasibility of PAE and study the pelvic arterial anatomy was performed in all patients [5][6][7]. If the PSA level was greater than 4 ng/mL or when the DRE or TRUS findings were suspicious, prostatic biopsy was performed to exclude malignancy.…”

Section: Methodsmentioning

confidence: 99%

“…However, PAE is a technically challenging procedure with unilateral embolization and technical failure reported rates of approximately 10-15 and 7 %, respectively [1][2][3][4]. To perform the procedure in a safe manner without nontarget embolization to periprostatic tissues, precise knowledge of the male pelvic and PA anatomy and imaging findings is required [5][6][7].…”

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confidence: 99%

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Unilateral Versus Bilateral Prostatic Arterial Embolization for Lower Urinary Tract Symptoms in Patients with Prostate Enlargement

Bilhim

Pisco²,

Fernandes

et al. 2012

Cardiovasc Intervent Radiol

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Purpose This study was designed to compare baseline data and clinical outcome between patients with prostate enlargement/benign prostatic hyperplasia (PE/BPH) who underwent unilateral and bilateral prostatic arterial embolization (PAE) for the relief of lower urinary tract symptoms (LUTS). Methods This single-center, ambispective cohort study compared 122 consecutive patients (mean age 66.7 years) with unilateral versus bilateral PAE from March 2009 to December 2011. Selective PAE was performed with 100-and 200-lm nonspherical polyvinyl alcohol (PVA) particles by a unilateral femoral approach.Results Bilateral PAE was performed in 103 (84.4 %) patients (group A). The remaining 19 (15.6 %) patients underwent unilateral PAE (group B). Mean follow-up time was 6.7 months in group A and 7.3 months in group B. Mean prostate volume, PSA, International prostate symptom score/ quality of life (IPSS/QoL) and post-void residual volume (PVR) reduction, and peak flow rate (Qmax) improvement were 19.4 mL, 1.68 ng/mL, 11.8/2.0 points, 32.9 mL, and 3.9 mL/s in group A and 11.5 mL, 1.98 ng/mL, 8.9/1.4 points, 53.8 mL, and 4.58 mL/s in group B. Poor clinical outcome was observed in 24.3 % of patients from group A and 47.4 % from group B (p = 0.04). Conclusions PAE is a safe and effective technique that can induce 48 % improvement in the IPSS score and a prostate volume reduction of 19 %, with good clinical outcome in up to 75 % of treated patients. Bilateral PAE seems to lead to better clinical results; however, up to 50 % This work reflects in part the work from Bilhim T. Embolização das artérias prostáticas no tratamento da hiperplasia benigna da próstata. PhD thesis,

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Section: Methodsmentioning

confidence: 99%

mentioning

confidence: 99%

Unilateral Versus Bilateral Prostatic Arterial Embolization for Lower Urinary Tract Symptoms in Patients with Prostate Enlargement

Bilhim

Pisco²,

Fernandes

et al. 2012

Cardiovasc Intervent Radiol

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111

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“…Cadaveric and imaging studies have described in detail the prostatic artery anatomy relevant for embolization (1,2,7,8). Prostatic arteries have highly variable origins from the branches of the internal iliac artery.…”

Section: Discussionmentioning

confidence: 99%

“…The rare incidence of prostatic arteries arising from AOAs (o 2% from our experience) may explain why it was not reported before. Previous studies on prostatic artery anatomy included o 75 patients (1,2,7,8), which was probably the reason for not reporting this variant.…”

Section: Discussionmentioning

confidence: 99%

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The Role of Accessory Obturator Arteries in Prostatic Arterial Embolization

Bilhim

Pisco²,

Pinheiro

et al. 2014

Journal of Vascular and Interventional Radiology

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In 9 of 491 patients (1.8%) who underwent prostatic arterial embolization (PAE) for benign prostatic hyperplasia from March 2009-November 2013, prostatic arteries arose from the external iliac artery via an accessory obturator artery (AOA). Computed tomography angiography performed before the procedure identified the variant and allowed planning before the procedure. The nine AOAs were catheterized from a contralateral femoral approach. Bilateral PAE was technically successful in the nine patients. There was a mean decrease in international prostate symptom score of 6.5 points and a mean prostate volume reduction of 15.1% (mean follow-up, 4.8 mo) in the nine patients. ABBREVIATIONSAOA = accessory obturator artery, DSA = digital subtraction angiography, IPSS = International Prostate Symptom Score, PAE = prostatic arterial embolization, PVA = polyvinyl alcohol, QoL = quality of life Prostatic arterial embolization (PAE) to relieve lower urinary tract symptoms in patients with benign prostatic hyperplasia is a challenging procedure partly because of the highly variable origin and complex anatomy of the prostatic arteries (1). Computed tomography (CT) angiography performed before PAE has been used to help identify the prostatic arteries and to guide the procedure (2). The prostatic arteries may arise from the different branches of the internal iliac artery, including from the obturator artery, in 13% of pelvic sides (1,2). However, the obturator artery may arise from the inferior epigastric artery or directly from the external iliac artery and be named an accessory or aberrant obturator artery (AOA). An AOA is a common variation that may be present in 30% of pelvic sides (3). Prostatic arteries arising from AOAs are a possible variant of particular relevance when performing PAE. The purpose of this report is to clarify this anatomic variation and report successful catheterization and embolization in nine patients with lower urinary tract symptoms related to benign prostatic hyperplasia. MATERIALS AND METHODSThe institutional review board waived the need to obtain permission to perform this retrospective analysis. From March 2009-November 2013, PAE was performed in 491 patients to relieve lower urinary tract symptoms secondary to benign prostatic hyperplasia. Nine patients with prostatic arteries arising from AOAs were included. AOAs were classified as (i) obturators arising from the inferior epigastric artery, (ii) obturators arising directly from the external iliac artery, or (iii) codominant obturators originating from both the external and the internal iliac artery systems (3).Among the nine patients evaluated, mean patient age was 62.9 years (range, 51-74 y). Mean International Prostate Symptom Score (IPSS) was 18.9 points (range, 14-21 points), mean quality of life (QoL) score was 4.0 points (range, 3-6 points). Mean peak flow rate was 11.2 mL/s (range, 5.9-13.5 mL/s), mean postvoid residual & SIR, 2014

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