SAN FRANCISCO, CA USA (UroToday.com) - Purpose: The aim of this study is to show that prostatic artery embolization (PAE) improves both quality of life (QoL) and lower urinary tract symptoms (LUTS) in patients with benign prostatic hyperplasia (BPH).
Materials and Methods: A prospective, single site, phase 2 study included 11 patients with acute urinary retention due to BPH who had been managed by medical treatment and indwelling urethral catheters and were waiting for transurethral resection of the prostate (TURP). International Prostate Symptom Score (IPSS) ranging from best to worst (range, 0-35), QoL and urodynamic testing were used to assess the outcome. Ages ranged from (59 to 78, mean 68.5 year-old) and prostate size ranged from 30-90 grams. Patients underwent physical examination, PSA measurement, transrectal US, and MRI. Twelve PAE procedures using 300-500μm Embospheres® were performed in 11 patients under local anesthesia.
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Results Technical success (bilateral PAE) was 75%, and clinical success (catheter removal and symptoms improvement) was 91% (10/11 patients). Patients urinated spontaneously from 4-25 days (mean, 12.1) after catheter removal. The most frequent related symptoms due to PAE were mild anal, urethral and retropubic pain. No major complication was observed. Minimum rectal bleeding (a teaspoon amount) was observed in 3/12 (25%), diarrhea in 2/12 (16.6%), and focal bladder ischemia in 1/12 (8.3%) procedures. Follow-up ranged from 11-40 months. Most significant gland shrinkage was observed during the initial six month follow-up and both US and MRI showed a mean of 30% volume reduction in the prostate size until last imaging follow-up. Clinical overall improvement in LUTS at one-year follow-up was assessed by IPSS (mean, 2.2) and QoL (mean, 0.25), and the urodynamic data corroborate the clinical improvement. All patients have higher urinary flow and reduced detrusor pressure compared to the pre-embolization urodynamic study and reported a high degree of satisfaction after PAE.
Conclusions: BPH can be safely treated by PAE with low side effects rates, reducing prostate volume by more than 30%, with LUTS relief and increased QoL in a selected group of patients with acute urinary retention.
Presented by Francisco Cesar Carnevale, MD, PhD* 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 Medical School
Sao Paulo, Brazil
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