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



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.


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).


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.


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



Benign prostatic hyperplasia


Bladder contractility index


Bladder outlet obstruction


Bladder outlet obstruction index


Cone beam computed tomography


Digital subtraction angiography


International Prostate Symptom Score


Lower urinary tract symptoms


Magnetic resonance imaging


Original prostate artery embolization


Prostate artery embolization


Proximal Embolization First Then Embolize Distal


Quality of life


Transurethral resection of the prostate


Maximum flow rate



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 ( 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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