Does polyvinyl alcohol particle size change the outcome of prostatic arterial embolization for benign prostatic hyperplasia? "Beyond the Abstract," by Tiago Bilhim, MD, PhD, EBIR

BERKELEY, CA (UroToday.com) - This study assessed the best embolic size for prostate artery embolization (PAE) with polyvinyl alcohol (PVA) particles. PVA particles that are too large may end up outside the prostate, leading to worse results due to less prostate ischemia. Smaller PVA particles may lead to greater prostate ischemia and better clinical results with a greater risk of complications.

We prospectively evaluated 80 patients and concluded that PAE is safe. Smaller PVA size did not lead to more complications. However, contrary to what was expected, smaller PVA was associated with worse clinical outcome. We believe this to be due to greater re-vascularization. Larger PVA may lead to best results due to lower re-vascularization after PAE.

PSA and prostate volume decreased more with smaller PVA, probably due to greater prostate ischemia. We believe that PAE with PVA should start with smaller (100-µm) PVA and end with larger (200-µm) PVA. The small number of patients, large dropout rates and the absence of MR imaging to assess prostate ischemia after PAE are the main limitations of the study. Also, we used irregular or particle PVA. With this embolic, precise calibration of size is very unpredictable. Future studies with a larger number of patients, comparing not only embolic size but different embolics, are needed. Studies comparing spherical vs non-spherical PVA; microspheres vs PVA should be performed. Whenever possible, MR imaging should also be used to assess prostate ischemia after PAE.

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

Does polyvinyl alcohol particle size change the outcome of prostatic arterial embolization for benign prostatic hyperplasia? Results from a single-center randomized prospective study - Abstract

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