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Benefits of Repeat Prostatic Artery Embolization on Persistent or Recurrent Lower Urinary Tract Symptoms in Patients with Benign Prostatic Hyperplasia

  • Clinical Investigation
  • Embolisation (arterial)
  • Published:
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Abstract

Objectives

To evaluate the benefits of repeat prostatic artery embolization (rePAE) for patients with persistent or recurrent symptoms after initial prostatic artery embolization (PAE).

Materials and Methods

This is a single-center retrospective study of all patients who underwent a rePAE between December 2014 and November 2020 for persistent or recurrent lower urinary tract symptoms. Symptoms were assessed before and after PAE and rePAE, using the International Prostate Symptom Score and quality of life (QoL) questionnaires. Patient characteristics, anatomical presentations, technical success rates, and complications of both procedures were collected. Clinical failure was defined as one of the following: less than 2 points’ decrease in QoL, a QoL score higher than 3, acute urinary retention, and secondary surgery.

Results

A total of 21 consecutive patients (mean age: 63.8 ± 8.1; [40–75] years) who underwent rePAE were included. The median follow-up after PAE was 27.7 [18.1–36.9]) months and 8.9 [3.4–10.8] months after rePAE. rePAE was performed at a mean of 19 ± 11.1 [6.9–49.6] months following PAE, and the overall clinical success rate was 33% (7/21). In patients undergoing rePAE because of persistent symptoms, the clinical success rate (18%) was non-significantly lower than that for patients treated for recurrent symptoms (50%) [OR 4.5 (95% CI 0.63–32 P = 0.13)]. The main anatomical revascularization pattern was recanalization of the native prostatic artery (29/45, 66%).

Conclusion

Patients who experience recurrent symptoms after PAE may benefit more from rePAE than those with persistent symptoms after PAE. Clinical success rates seem to be relatively low in both clinical scenarios.

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Abbreviations

BPH:

Benign prostatic hyperplasia

DSA:

Digital subtraction angiography

CBCT:

Cone-beam computed tomography

IIEF:

International Index of Erectile Function

IPP:

Intravesical prostatic protrusion

IPSS:

International Prostate Symptom Score

PA:

Prostatic artery

PAE:

Prostatic artery embolization

PVR:

Post-void residual

Qmax:

Maximum flow rate

QoL:

Quality of life

rePAE:

Repeat prostatic artery embolization

TURP:

Transurethral resection of the prostate

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Funding

This study was not supported by any funding.

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Authors and Affiliations

  1. Vascular and Oncological Interventional Radiology, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France

    Raphael Lehrer, Marc Sapoval, Alessandro Di Gaeta, Charles Querub, Marc Al Ahmar, Carole Dean, Olivier Pellerin & Tom Boeken

  2. Faculté de Santé, Université de Paris Cité, Paris, France

    Marc Sapoval, Charles Querub, Olivier Pellerin & Tom Boeken

  3. PARCC U 970, INSERM, Université de Paris Cité, Paris, France

    Marc Sapoval, Carole Dean, Olivier Pellerin & Tom Boeken

  4. HeKA Team, INRIA, Paris, France

    Tom Boeken

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  1. Raphael Lehrer
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Correspondence to Tom Boeken.

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Conflict of interest

The authors declare that they have no conflict of interest. Marc Sapoval received honorarium and research grant by Merit Medical.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This was an institutional review board-approved retrospective monocentric study and the need for informed consent was waived.

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Lehrer, R., Sapoval, M., Di Gaeta, A. et al. Benefits of Repeat Prostatic Artery Embolization on Persistent or Recurrent Lower Urinary Tract Symptoms in Patients with Benign Prostatic Hyperplasia. Cardiovasc Intervent Radiol 46, 739–745 (2023). https://doi.org/10.1007/s00270-023-03424-y

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