BERKELEY, CA (UroToday.com) - Prostatic embolization for the treatment of benign prostatic hyperplasia (BPH) started, as many of the practices in interventional radiology, by chance, in 2000 when Demeritt et al., treated a spontaneous prostatic bleeding in a patient with BPH using the traditional embolization techniques. To their surprise, during follow up, the authors noted relief of symptoms associated with BPH. Since then, there have principally been two authors who have described prostatic artery embolisation (PAE) as an alternative and minimally invasive technique for relief of lower urinary tract symptoms (LUTS) in patients with prostatic enlargement.
Since May 2012, in our institution, we treated 25 patients with BPH and LUTS refractory to medical therapy. The indication for treatment was given by a team of urologists and interventional radiologists for patients who were ineligible or refused traditional surgical-endoscopic treatment. Before PAE, every patient underwent clinical evaluation including digital rectal evaluation, IPSS, QL and IIEF5 scoring, uroflowmetry, prostate-specific antigen (PSA) level measurement, transrectal ultrasound examination, and computed tomography angiography. PAE was performed in angiographic suite using right femoral access and embolization was performed after super-selective catheterization of one or two prostatic arteries using microsphere (300-500 micron). The average hospitalization was 3 days.
Every patient (median follow-up of 244 days) showed a significant reduction of IPSS (mean value of IPSS-pre =29.5/mean value of IPSS-post=12.25), of QL (from 4.75 to 1.75), and improvement of IIEF (from 8.83 to 11.42) at 6-month follow up. Prostatic volume showed a mean reduction of 32.8% at 3 months follow-up. Our study showed no major or minor complications, however, in the literature, two papers described a non-target embolization of cystic and rectal embolization resulting in cystic wall necrosis and in transient rectal ischemia.
In our experience PAE is a very innovative and promising technique in BPH management. However, it is important to perform the procedure in an experienced center with a skilled interventional radiology team. In fact, anatomical variation of prostatic artery origin and the arterial map tortuosity sometimes require a long procedural time (in our study the procedure duration was a mean of 110 minutes). In order to achieve optimal results, both a multidisciplinary approach and a close collaboration between urologists and interventional radiologists are required.
Written by:
Alberto Balderi,a Maurizio Grosso,a and Giuseppe Arenab 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.
aRadiology Department, Santa Croce e Carle Hospital, Via Coppino 26, 12100, Cuneo, Italy
bUrology Department, Santa Croce e Carle Hospital, Via Coppino 26, 12100, Cuneo, Italy
Prostatic artery embolization in benign prostatic hyperplasia: Preliminary results in 13 patients - Abstract