Presented by Francisco C. Carnevale, Vascular Interventional Radiology; University of São Paulo Medical School, Brazil
The surgical management of BPH (prostate enlargement with associated lower urinary tract symptoms) has continued to evolve in the direction of options that successfully relieve the urinary problem but minimize procedural complication risks and economical costs.
Perhaps the latest entry in this pursuit is prostate embolization, a new technology intended to relieve prostatic obstruction in a safe, minimally invasive manner. At the XXXIII Brazilian Congress of Urology, Dr. Carnevale and associates reported on a prospective, single-site, phase II study involving 11 patients (aged 59 to78 years old) who had failed oral alpha-blocker medical therapy and required indwelling urethral catheterization. They described their results using a novel, interventional, radiologic procedure in which the vascular supply of the prostate is mapped and then selectively embolized with microspheres (300 to 500 µm Embospheres). The procedures were done in an outpatient fashion in approximately 2.5 hours. During the clinical follow-up, ranging from 11 to 40 months, the investigators assessed clinical success (catheter removal at a mean duration of 12.1 days and symptom improvement) in 10 of 11 (91%) patients. One year after treatment, patients had recorded improved International Prostate Symptom Scores (mean 2.2) and improved quality of life scores, and improvement was associated with an increased mean urinary flow rate of 10.8 ml/sec from 3.6 ml/sec at baseline. Imaging studies (ultrasound and MRI) showed a 30% mean reduction of prostate volume that was maintained during follow-up. Adverse effects were limited to mild pain in the perineal region in all patients, minimal rectal bleeding in 3 of 12 (25%) patients, diarrhea in 2 of 12 (16.6%), and focal bladder ischemia in 1 of 12 (8.3%) patients. No major complications were observed.
This therapy offers a new approach for BPH treatment that does not involve surgically induced tissue destruction or ablation. The technique applies knowledge of the vascular supply of the prostate, and apparently relies on prostatic tissue involution effected by ischemia. It technically resembles embolization techniques used for treating uterine fibroids by minimally invasive advances in the gynecologic field. Its appeal is readily discernible by its short-term outpatient course, acceptable procedural times, from the health care provider’s perspective, and both its convenience and toleration from the patient’s perspective. The outpatient management approach would also seem advantageous in reducing health care costs.
Although prostate embolization elicits excitement and suggests promise within the BPH treatment armamentarium, the treatment remains preliminary at present and awaits further study. Potential limitations include its non-diagnostic tissue yield, the need for radiologic expertise, and equipment for its execution. Long-term evaluations will be necessary to determine if the therapy has sufficient durability and obviates retreatments. In addition, ongoing study will be useful to define optimal clinical indications for this therapy, which may be influenced by certain clinical presentations, prostate anatomical sizes or features, and possibly periprostatic, vascular supply variations.
Presented by Francisco C. Carnevale, M.D., PhD at the Brazilian Congress of Urology, November 22 - 26, 2011 Santa Catarina, Brazil
Reported for UroToday by:
Arthur L. Burnett, M.D., M.B.A., F.A.C.S.
Dr. Arthur (Bud) Burnett received his A.B. degree in Biology from Princeton University and M.D. and M.B.A. degrees from Johns Hopkins University. His post-graduate training in general surgery, urology, and reconstructive urology and urodynamics was performed at the Johns Hopkins Hospital. He received an American Foundation for Urologic Disease scholarship and joined the faculty at the Johns Hopkins University School of Medicine. He is currently the Patrick C. Walsh Professor of Urology and is the Director of the Basic Science Laboratory in Neuro-urology of the James Buchanan Brady Urological Institute and Director of the Sexual Medicine Division. He is an alumni member of the Alpha Omega Alpha Honor Medical Society and Fellow of the American College of Surgeons.
The opinions expressed in this article are those of the UroToday.com Contributing Medical Editor and do not necessarily reflect the viewpoints of the Brazilian Congress of Urology.
View Slide Presentation (in Portugese)
