Dr Antunes reported the aim of this pilot study was to evaluate an alternative, minimally invasive therapy for men with severe BPH and acute urinary retention, managed with indwelling catheters. The urologists and interventional radiologists at the University of Sao Paulo Medical Center developed the prostatic arterial embolization (PAE) protocol as an outpatient procedure. For this study, all 10 patients in the study from 2008-2010 were thoroughly evaluated by the urologist utilizing a TURP pre-op protocol (urodynamic testing, PSA, and biospy if concerned). MRI and rectal ultrasound was part of the IR protocol with urology to better evaluate the prostate reduction size. No significant adverse events were reported after a six month follow-up. Antunes reported 90 percent clinical success and a 30 percent mean average reduction in symmetrical prostate volume.
As discussed in this session, there were no significant adverse events related to PAE arterial access through the groin in contrast to TURP access through the urethra. “Urethral access poses changes that are sometimes irreversible,” said Antunes. The embolic Embosphere microspheres optimally occluded the arterial flow until the endpoint of statis was achieved bilaterally. Using this technique, the prostate demonstrated symmetrical volume reduction. Only mild discomfort was reported by the patients; patients received NSAIDS. Symptom relief and catheter removel was achieved in 9 patients (uni-and bilateral) with a mean time of 12 days. In one patient, the procedure was unsuccessful with a prostate reduction of 5 percent, and the catheter was not removed. This patient was referred for TURP and the urologist observed less than normal bleeding during the TURP procedure. Overall, the QoL rating by patients indicated they were very pleased with the outcome based on LUTS relief.
Antunes was asked by urologists if any of the patients experienced erectile dysfunction from the PAE procedure. He reported that none of the patients experience erectile dysfunction from the PAE procedure. He concluded, prostatic arterial embolization demonstrates promising results for patients with BPH. Further study is needed to evaluated a controlled, randomized study comparing PAE to the gold standard method (which is TURP) in patients with all types of BPH (with or without catheters).
View slides from this presentation by Alberto A. Antunes, MD
Note: In addition to the Sao Paulo study, two other BPH AUA moderated posters addressed embolization of prostate arteries as a safe and effective technique for BPH management:
Endovascular superselective embolization of prostatic arteries as the new method of BPH less invasive treatment
Ivan Dedov, Dmitry Kurbatov, Ivan Sitkin, Moscow, Russian Federation, Alexander Neimark, Ekaterina Yakovets, Barnaul, Russian Federation, Alexander Lepetuhin, Sergey Dubsky, Moscow, Russian Federation, and
Prostatic artery embolization to treat benign prostatic hyperplasia - short and medium term outcomes
Luis Campos Pinheiro, Joao Pisco, Tiago Bilhim, Vitor Vaz Santos, Joao O'Neill, Lisbon, Portugal Abstracts 2115 Moscow, Russia Federation; 2267, Lisbon, Portugal.
Presented by Alberto A. Antunes, MD at the American Urological Association (AUA) Annual Meeting - May 14 - 19, 2011 - Walter E. Washington Convention Center, Washington, DC USA
Reported by Karen Roberts, Medical Writer, UroToday.com
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