Unilateral vs bilateral prostatic arterial embolization for lower urinary tract symptoms in patients with prostate enlargement, "Beyond the Abstract," by Tiago Bilhim, MD, PhD, EBIR

BERKELEY, CA (UroToday.com) - For BPH patients, prostate arterial embolization (PAE) has been shown to reduce LUTS and to be safe. However, this is a new and challenging interventional radiology procedure that relies on the correct identification and catheterization of prostatic arteries. Knowledge of the male pelvic and prostatic artery anatomy is mandatory to achieve successful embolization.

Bilateral embolization should be attempted in every case because the vascular supply to the prostate almost always depends on both pelvic sides. However, up to 15% of patients have unilateral embolization procedures due to technical difficulties (small and very tortuous arteries, atherosclerotic changes, very angulated arterial origins, etc.). This is the only study, until now, to compare the baseline data and clinical outcomes of patients with unilateral PAE as compared with bilateral PAE.

Unilateral procedures are more frequent in older patients as they tend to have more atherosclerotic changes and tortuous iliac arteries. Unilateral PAE leads to worse results and may be one of the possible explanations of why some patients, after PAE, do not have good clinical outcomes. As this was a non-randomized, ambispective study, there was no control for all possible measured and unmeasured confounders. The extent to which unilateral PAE compromises clinical outcomes after the procedure may be over or underestimated. However, herein we show that unilateral PAE is more likely in older patients and leads to worse clinical outcomes when compared with bilateral PAE. Bilateral PAE should always be attempted.

Written by:
Tiago Bilhim, MD, PhD, EBIR as part of Beyond the Abstract on UroToday.com. This initiative offers a method of publishing for the professional urology community. Authors are given an opportunity to expand on the circumstances, limitations etc... of their research by referencing the published abstract.

Department of Anatomy, Faculdade de Ciências Médicas (FCM), Universidade Nova de Lisboa, Lisbon, Portugal
Department of Radiology, Faculdade de Ciências Médicas (FCM), Universidade Nova de Lisboa, Lisbon, Portugal
Department of Interventional Radiology, Hospital Saint Louis, Lisbon, Portugal

 

Unilateral versus bilateral prostatic arterial embolization for lower urinary tract symptoms in patients with prostate enlargement - Abstract

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