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Recurrence of Lower Urinary Tract Symptoms Following Prostate Artery Embolization for Benign Hyperplasia: Single Center Experience Comparing Two Techniques

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Abstract

Purpose

To compare recurrence of lower urinary tract symptoms (LUTS) recurrence at 12 months following original prostate artery embolization (oPAE) or “proximal embolization first, then embolize distal” (PErFecTED) PAE for benign prostatic hyperplasia (BPH).

Materials and Methods

105 consecutive patients older than 45 years, with prostate size greater than 30 cm3, International Prostate Symptom Score (IPSS) ≥ 8, quality of life (QoL) index ≥ 3, and refractory status or intolerance of medical management were prospectively enrolled between June 2008 and August 2013. The study was IRB-approved, and all patients provided informed consent. Patients underwent oPAE or PErFecTED PAE and were followed for at least 12 months. Technical success was defined as bilateral embolization and clinical success (non-recurrence) was defined as removal of the Foley catheter in patients with urinary retention, IPSS < 8 and QoL index < 3 at 12 months of follow-up. Nonparametric statistics were used to compare the study groups due to the size of the study population and distributions of clinical data.

Results

97 patients had 12-month data and were categorized as oPAE without recurrence (n = 46), oPAE with recurrence (n  = 13), PErFecTED without recurrence (n  = 36), or PErFecTED with recurrence (n  = 2). Recurrence was significantly more common in oPAE patients (χ 2, p = 0.026). Unilateral embolization was significantly associated with recurrence among patients who underwent oPAE (χ 2, p = 0.032).

Conclusions

Both oPAE and PErFecTED PAE are safe and effective methods for treatment of LUTS, but PErFecTED PAE is associated with a significantly lower rate of symptom recurrence.

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Abbreviations

BPH:

Benign prostatic hyperplasia

BCI:

Bladder contractility index

BOO:

Bladder outlet obstruction

BOOI:

Bladder outlet obstruction index

CBCT:

Cone beam computed tomography

DSA:

Digital subtraction angiography

IPSS:

International Prostate Symptom Score

LUTS:

Lower urinary tract symptoms

MRI:

Magnetic resonance imaging

oPAE:

Original prostate artery embolization

PAE:

Prostate artery embolization

PErFecTED:

Proximal Embolization First Then Embolize Distal

QoL:

Quality of life

TURP:

Transurethral resection of the prostate

Qmax :

Maximum flow rate

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Funding

Merit Medical Systems, Inc. provided research grant funding to support the first 11 patients treated at our institution, 10 of whom are described in this manuscript. Several cases included in this dataset were treated during Merit-funded training courses in support of the BPH-P3-12-01 study (ClinicalTrials.gov identifier NCT01789840). None of the authors were paid to write or submit this manuscript, and all had access to data used in the analyses.

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Authors and Affiliations

  1. Department of Radiology, University of Sao Paulo, Av. Dr. Enéas de Carvalho Aguiar, 255, São Paulo, SP, 05403-001, Brazil

    Francisco Cesar Carnevale, Airton Mota Moreira, Andre Moreira de Assis & Giovanni Guido Cerri

  2. Department of Urology, University of Sao Paulo, Sao Paulo, Brazil

    Miguel Srougi & Alberto Azoubel Antunes

  3. The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH, USA

    Sardis Honoria Harward

  4. Department of Interventional Radiology, University of Miami Medical Center, Miami, FL, USA

    Shivank Bhatia

Authors
  1. Francisco Cesar Carnevale
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  2. Airton Mota Moreira
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  3. Sardis Honoria Harward
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  4. Shivank Bhatia
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  5. Andre Moreira de Assis
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  6. Miguel Srougi
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  7. Giovanni Guido Cerri
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  8. Alberto Azoubel Antunes
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Corresponding author

Correspondence to Francisco Cesar Carnevale.

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Conflict of interest

FCC, SHH, and SB are research consultants to Merit Medical Systems, Inc. FCC receives patent royalties and SB has received research grants from Merit Medical Systems, neither of which were associated with this project.

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Carnevale, F.C., Moreira, A.M., Harward, S.H. et al. Recurrence of Lower Urinary Tract Symptoms Following Prostate Artery Embolization for Benign Hyperplasia: Single Center Experience Comparing Two Techniques. Cardiovasc Intervent Radiol 40, 366–374 (2017). https://doi.org/10.1007/s00270-017-1569-5

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