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

Abstract

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,

The Role of Prostatic Arterial Embolization in Patients with Benign Prostatic Hyperplasia: A Systematic Review

“…Potential conflict of interest was unclear in four studies [14,17,18,20]. In one study, the authors stated a potential conflict of interest (Cook Medical; speaker/honoraria; consultant/advisory board) [19].…”

“…Of the nine studies, eight were cohort studies [14][15][16][17][19][20][21][22]. Only one study, comparing two different sizes of PVA particles, was a randomized, controlled trial [18].…”

“…However, we presume that interventional radiologists also performed the procedure in the other studies. The embolization procedure was performed using 90-180 or 180-300 lm nonspherical polyvinyl alcohol (PVA) particles [14][15][16][17][18][19], 300-500 lm microspheres [20,21], or 100-400 lm spherical embolic agents [22]. Mean total procedure time varied from 70.4 to 96.3 min (mean of the means 80.1 min), and the mean fluoroscopy time varied from 18 to 85.9 min (mean of the means 36.5 min).…”

“…Most studies had the intention to perform the embolization bilaterally; however, in some cases only unilateral embolization was performed due to atherosclerosis. One cohort study compared bilateral versus unilateral embolization [19]. In total, 564 patients underwent a bilateral embolization, 91 a unilateral embolization, and for 22 patients it was unclear if one or both sides were treated [20,21].…”

“…After checking the inclusion and exclusion criteria, one study was excluded based on Chinese language. All data were extracted from the nine studies eligible for the systematic review (Supplement 1) [14][15][16][17][18][19][20][21][22]. These nine studies were all published by three research groups, with probably an overlap of patients.…”