CardioVascular and Interventional Radiology

, Volume 36, Issue 4, pp 978–986 | Cite as

Clinical, Laboratorial, and Urodynamic Findings of Prostatic Artery Embolization for the Treatment of Urinary Retention Related to Benign Prostatic Hyperplasia. A Prospective Single-Center Pilot Study

  • Alberto A. Antunes
  • Francisco C. CarnevaleEmail author
  • Joaquim M. da Motta Leal Filho
  • Eduardo M. Yoshinaga
  • Luciana M. O. Cerri
  • Ronaldo H. Baroni
  • Antonio S. Z. Marcelino
  • Giovanni G. Cerri
  • Miguel Srougi
Clinical Investigation



This study was designed to describe the clinical, laboratorial, and urodynamic findings of prostatic artery embolization (PAE) in patients with urinary retention due to benign prostatic hyperplasia (BPH).


A prospective study of 11 patients with urinary retention due to BPH was conducted. Patients underwent physical examination, prostate specific antigen (PSA) measurement, transrectal ultrasound, and magnetic resonance imaging. International prostate symptom score (IPSS), quality of life (QoL), and urodynamic testing were used to assess the outcome before and after 1 year.


Clinical success was 91 % (10/11 patients) with a mean follow-up of 22.3 months (range, 12–41 months). At the first year follow-up, the mean IPSS score was 2.8 points (p = 0.04), mean QoL was 0.4 points (p = 0.001), mean PSA decreased from 10.1 to 4.3 ng/mL (p = 0.003), maximum urinary flow (Qmax) improved from 4.2 to 10.8 mL/sec (p = 0.009), and detrusor pressure (Pdet) decreased from 85.7 to 51.5 cm H2O (p = 0.007). Before PAE, Bladder Outlet Obstruction Index (BOOI) showed values >40 in 100 % of patients. After PAE, 30 % of patients were >40 (obstructed), 40 % were between 20 and 40 (undetermined), and 30 % were <20 (unobstructed). Patients with a BOOI <20 had higher PSA values at 1-day after PAE.


Clinical and urodynamic parameters improved significantly after PAE in patients with acute urinary retention due to BPH. Total PSA at day 1 after PAE was higher in patients with unobstructed values in pressure flow studies.


Clinical practice Imaging Arterial intervention Embolization/embolisation/ embolotherapy Endovascular treatment Transcatheter therapy MRI/ MRA Prostate Urinary tract 


Conflict of interest

Alberto Azoubel Antunes, Francisco Cesar Carnevale, Joaquim Mauricio da Motta-Leal-Filho, Eduardo Muracca Yoshinaga, Luciana Mendes de Oliveira Cerri, Ronaldo Hueb Baroni, Antonio Sergio Zafred Marcelino, Giovanni Guido Cerri, Miguel Srougi have no conflict of interest.


  1. 1.
    McVary KT (2006) BPH: epidemiology and comorbidities. Am J Manage Care 12(5 Suppl):122–128Google Scholar
  2. 2.
    Madersbacher S, Alivizatos G, Nordling J, Sanz CR, Emberton M, de la Rosette JJ (2004) EAU 2004 guidelines on assessment, therapy and follow-up of men with lower urinary tract symptoms suggestive of benign prostatic obstruction (BPH guidelines). Eur Urol 46:547–554PubMedCrossRefGoogle Scholar
  3. 3.
    McVary KT, Roehrborn CG, Avins AL et al (2011) Update on AUA guideline on the management of benign prostatic hyperplasia. J Urol 185(5):1793–1803PubMedCrossRefGoogle Scholar
  4. 4.
    Rassweiler J, Teber D, Kuntz R, Hofmann R (2006) Complications of transurethral resection of the prostate (TURP): incidence, management, and prevention. Eur Urol 50(5):969–979PubMedCrossRefGoogle Scholar
  5. 5.
    Mitchell ME, Waltman AC, Athanasoulis CA, Kerr WS Jr, Dretler SP (1976) Control of massive prostatic bleeding with angiographic techniques. J Urol 115(6):692–695PubMedGoogle Scholar
  6. 6.
    Bischoff W, Goerttler U (1977) Successful intra-arterial embolization of bleeding carcinoma of the prostate. Urologe A 16:99–102PubMedGoogle Scholar
  7. 7.
    Nadalini VF, Positano N, Bruttini GP, Medica M, Fasce L (1981) Therapeutic occlusion of the hypogastric arteries with isobutyl-2-cyanoacrylate in vesical and prostatic cancer. Radiol Med 67(1–2):61–66PubMedGoogle Scholar
  8. 8.
    Appleton DS, Sibley GN, Doyle PT (1988) Internal iliac artery embolisation for the control of severe bladder and prostate haemorrhage. Br J Urol 61(1):45–47PubMedCrossRefGoogle Scholar
  9. 9.
    DeMeritt JS, Elmasri FF, Esposito MP, Rosemberg GS (2000) Relief of benign prostatic hyperplasia-related bladder outlet obstruction after transarterial polyvinyl alcohol prostate embolization. J Vasc Interv Radiol 11(6):767–770PubMedCrossRefGoogle Scholar
  10. 10.
    Barbieri A, Simonazzi M, Marcato C et al (2002) Massive hematuria after transurethral resection of the prostate: management by intra-arterial embolization. Urol Int 69(4):318–320PubMedCrossRefGoogle Scholar
  11. 11.
    Michel F, Dubruille T, Cercueil JP, Paparel P, Cognet F, Krause D (2002) Arterial embolization for massive hematuria following transurethral prostatectomy. J Urol 168(6):2550–2551PubMedCrossRefGoogle Scholar
  12. 12.
    Rastinehad AR, Caplin DM, Ost MC et al (2008) Selective arterial prostatic embolization (SAPE) for refractory hematuria of prostatic origin. Urology 71(2):181–184PubMedCrossRefGoogle Scholar
  13. 13.
    Tan L, Venkatesh SK, Consigliere D, Heng CT (2009) Treatment of a patient with post-TURP hemorrhage using bilateral SAPE. Nat Rev Urol 6(12):680–685PubMedCrossRefGoogle Scholar
  14. 14.
    Sun F, Sánchez FM, Crisóstomo V et al (2008) Benign prostatic hyperplasia: transcatheter arterial embolization as potential treatment—preliminary study in pigs. Radiology 246(3):783–789PubMedCrossRefGoogle Scholar
  15. 15.
    Jeon GS, Won JH, Lee BM et al (2009) The effect of transarterial prostate embolization in hormone-induced benign prostatic hyperplasia in dogs: a pilot study. J Vasc Interv Radiol 20(3):384–390PubMedCrossRefGoogle Scholar
  16. 16.
    Carnevale FC, Antunes AA, da Motta-Leal-Filho JM et al (2010) Prostatic artery embolization as a primary treatment for benign prostatic hyperplasia: preliminary results in two patients. Cardiovasc Intervent Radiol 33(2):355–361PubMedCrossRefGoogle Scholar
  17. 17.
    Carnevale FC, da Motta-Leal-Filho JM, Antunes AA et al (2011) Midterm follow-up after prostate embolization in two patients with benign prostatic hyperplasia. Cardiovasc Intervent Radiol 34(6):1330–1333PubMedCrossRefGoogle Scholar
  18. 18.
    Schäfer W, Abrams P, Liao L et al (2002) Good urodynamic practices: uroflowmetry, filling cystometry, and pressure-flow studies. Neurourol Urodyn 21:261–274PubMedCrossRefGoogle Scholar
  19. 19.
    Abrams P (1999) Bladder outlet obstruction index, bladder contractility index and bladder voiding efficiency: three simple indices to define bladder voiding function. BJU Int 84(1):14–15PubMedCrossRefGoogle Scholar
  20. 20.
    Kuntz RM, Ahyai S, Lehrich K, Fayad A (2004) Transurethral holmium laser enucleation of the prostate versus transurethral electrocautery resection of the prostate: a randomized prospective trial in 200 patients. J Urol 172:1012–1016PubMedCrossRefGoogle Scholar
  21. 21.
    Muzzonigro G, Milanese G, Minardi D, Yehia M, Galosi AB, Dellabella M (2004) Safety and efficacy of transurethral resection of prostate glands up to 150 mL: a prospective comparative study with 1 year of followup. J Urol 172:611–615PubMedCrossRefGoogle Scholar
  22. 22.
    Pisco JM, Pinheiro LC, Bilhim T, Duarte M, Mendes JR, Oliveira AG (2011) Prostatic artery embolization to treat benign prostatic hyperplasia. J Vasc Interv Radiol 22(1):11–19PubMedCrossRefGoogle Scholar
  23. 23.
    Carnevale FC, da Motta-Leal-Filho JM, Antunes AA et al (2013) Quality of life and clinical symptoms improvement support prostatic artery embolization for patients with acute urinary retention due to benign prostatic hyperplasia. J Vasc Interv Radiol. doi: 10.1016/j.jvir.2012.12.019
  24. 24.
    Milord RA, Kahane H, Epstein JI (2000) Infarct of the prostate gland: experience on needle biopsy specimens. Am J Surg Pathol 24(10):1378–1384PubMedCrossRefGoogle Scholar
  25. 25.
    Cross MJ, Claesson-Welsh L (2001) FGF and VEGF function in angiogenesis: signalling pathways, biological responses and therapeutic inhibition. Trends Pharmacol Sci 22:201–207PubMedCrossRefGoogle Scholar
  26. 26.
    Antunes AA, de Freire G C, Aiello Filho D, Cury J, Srougi M (2006) Analysis of the risk factors for incidental carcinoma of the prostate in patients with benign prostatic hyperplasia. Clinics (São Paulo) 61(6):545–550Google Scholar

Copyright information

© Springer Science+Business Media New York and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2013

Authors and Affiliations

  • Alberto A. Antunes
    • 1
    • 6
  • Francisco C. Carnevale
    • 2
    Email author
  • Joaquim M. da Motta Leal Filho
    • 2
  • Eduardo M. Yoshinaga
    • 1
  • Luciana M. O. Cerri
    • 3
  • Ronaldo H. Baroni
    • 4
  • Antonio S. Z. Marcelino
    • 3
  • Giovanni G. Cerri
    • 5
  • Miguel Srougi
    • 1
  1. 1.Division of UrologyUniversity of Sao Paulo Medical SchoolSão PauloBrazil
  2. 2.Interventional Radiology UnitUniversity of Sao Paulo Medical SchoolSão PauloBrazil
  3. 3.Ultrasound UnitUniversity of Sao Paulo Medical SchoolSão PauloBrazil
  4. 4.Magnetic Resonance UnitUniversity of Sao Paulo Medical SchoolSão PauloBrazil
  5. 5.Radiology DepartmentUniversity of Sao Paulo Medical SchoolSão PauloBrazil
  6. 6.São PauloBrazil

Personalised recommendations