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CardioVascular and Interventional Radiology

, Volume 40, Issue 3, pp 366–374 | Cite as

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

  • Francisco Cesar CarnevaleEmail author
  • Airton Mota Moreira
  • Sardis Honoria Harward
  • Shivank Bhatia
  • Andre Moreira de Assis
  • Miguel Srougi
  • Giovanni Guido Cerri
  • Alberto Azoubel Antunes
Clinical Investigation

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.

Keywords

Prostatic artery embolization Benign prostatic hyperplasia Lower urinary tract symptoms International Prostate Symptom Score 

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

Notes

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.

Compliance with Ethical Standard

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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Copyright information

© Springer Science+Business Media New York and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2017

Authors and Affiliations

  • Francisco Cesar Carnevale
    • 1
    Email author
  • Airton Mota Moreira
    • 1
  • Sardis Honoria Harward
    • 3
  • Shivank Bhatia
    • 4
  • Andre Moreira de Assis
    • 1
  • Miguel Srougi
    • 2
  • Giovanni Guido Cerri
    • 1
  • Alberto Azoubel Antunes
    • 2
  1. 1.Department of RadiologyUniversity of Sao PauloSão PauloBrazil
  2. 2.Department of UrologyUniversity of Sao PauloSao PauloBrazil
  3. 3.The Dartmouth Institute for Health Policy and Clinical PracticeLebanonUSA
  4. 4.Department of Interventional RadiologyUniversity of Miami Medical CenterMiamiUSA

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