SAN FRANCISCO, CA USA (UroToday.com) - Purpose: The aim of this paper is to describe the angiographic aspects of prostate vascular anatomy, drawing attention to the potential technical difficulties and complications during prostatic arterial embolization for the treatment of benign prostatic hyperplasia.
Materials: This study had local ethical committee approval; all patients gave written informed consent. A prospective phase I/II study was undertaken between June 2008 and November 2010, and included 11 male patients, mean age 68.5 years-old (range, 59 to 78). All patients presented with acute urinary retention and bladder catheters due to benign prostatic hyperplasia, refractory to medical treatment, with a clinical indication for transurethral prostatectomy and were submitted to prostatic arterial embolization. Angiographic and anatomic examinations were performed jointly by two interventional radiologists. Special attention was given to the origin, width, course, and branches of the inferior vesical artery and the prostatic branches. Anastomoses were searched for.
Results Twelve angiographic studies were performed in 11 patients. A total of 22 pelvic halves were analyzed. Clinical success was achieved in 91% (10 of the 11 patients), with a mean prostate volume reduction of over 30% at 6 months follow-up. Throughout this study, some features of the prostatic vascular anatomy were observed. The most frequent origin of the inferior vesical artery and its prostatic branches was as a third branch of the anterior trunk of the internal iliac artery (n = 10; 43.5%). The majority of patients presented a maximum diameter of the inferior vesical arteries (n = 21; 91.3%) of 2.5mm or less (average 2.15mm). Each inferior vesical artery emits from two to four prostatic arterial branches. Many anastomoses were identified among the inferior vesical artery and the surrounding arteries (n= 10; 43.5%).
Conclusions: There needs to be better knowledge of vascular prostatic anatomy in order to avoid serious complications during prostatic arterial embolizations for the treatment of benign prostatic hyperplasia, since these arteries have varying origins, reduced diameters, tortuosity and many anastomoses with other neighboring organs arteries.
Presented by Joaquim Motta Leal Filho, MD* at the 37th Annual Scientific Meeting of the Society of Interventional Radiology (SIR) - March 24 - 29, 2012 - Moscone Center - San Francisco, CA USA
*University of Sao Paulo
Sao Paulo, Brazil
View SIR 2012 Annual Meeting Coverage
