Prostatic Artery Embolization as a Primary Treatment for Benign Prostatic Hyperplasia: Preliminary Results in Two Patients

Abstract

Symptomatic benign prostatic hyperplasia (BPH) typically occurs in the sixth and seventh decades, and the most frequent obstructive urinary symptoms are hesitancy, decreased urinary stream, sensation of incomplete emptying, nocturia, frequency, and urgency. Various medications, specifically 5-α-reductase inhibitors and selective α-blockers, can decrease the severity of the symptoms secondary to BPH, but prostatectomy is still considered to be the traditional method of management. We report the preliminary results for two patients with acute urinary retention due to BPH, successfully treated by prostate artery embolization (PAE). The patients were investigated using the International Prostate Symptom Score, by digital rectal examination, urodynamic testing, prostate biopsy, transrectal ultrasound (US), and magnetic resonance imaging (MRI). Uroflowmetry and postvoid residual urine volume complemented the investigation at 30, 90, and 180 days after PAE. The procedure was performed under local anesthesia; embolization of the prostate arteries was performed with a microcatheter and 300- to 500-μm microspheres using complete stasis as the end point. One patient was subjected to bilateral PAE and the other to unilateral PAE; they urinated spontaneously after removal of the urethral catheter, 15 and 10 days after the procedure, respectively. At 6-month follow-up, US and MRI revealed a prostate reduction of 39.7% and 47.8%, respectively, for the bilateral PAE and 25.5 and 27.8%, respectively, for the patient submitted to unilateral PAE. The early results, at 6-month follow-up, for the two patients with BPH show a promising potential alternative for treatment with PAE.

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

“…PAE is considered technically challenging and unilateral PAE has been reported in all of these preliminary studies [2][3][4]. In the present study, 15.6 % of patients underwent unilateral embolization due to significant atherosclerotic lesions and tortuosity of the iliac and prostatic arteries.…”

“…Keywords Prostatic arterial embolization Á Unilateral Á Benign prostatic hyperplasia Á Lower urinary tract symptoms Preliminary studies have shown that prostatic arterial embolization (PAE) for the relief of lower urinary tract symptoms (LUTS) in patients with prostate enlargement/ benign prostatic hyperplasia (PE/BPH) is a promising, new, minimally invasive, image-guided therapy [1][2][3][4]. 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].…”

“…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].…”

“…One of the reported series [2,4] included one patient with unilateral embolization (with almost 20 % reduction in prostate volume and 11 % PSA reduction) and another with bilateral PAE (with almost 50 % reduction in prostate volume and 82 % PSA reduction). Both patients had significant clinical relief.…”

Prostatic Arterial Embolization to Treat Benign Prostatic Hyperplasia

“…The first report of this technique in the management of BPH in humans was by DeMeritt et al (14), who reported a single case of BPH with obstructive symptoms and blood loss refractory to other treatments that was successfully managed by PAE with 150 -250-m polyvinyl alcohol (PVA) particles. More recently there has been a report of two other patients in similar clinical scenarios treated with success with the use of 300 -500-m microspheres (15).…”