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