Prostatic Artery Embolization as an Alternative to Indwelling Bladder Catheterization to Manage Benign Prostatic Hyperplasia in Poor Surgical Candidates
- 882 Downloads
To prospectively assess discontinuation of indwelling bladder catheterization (IBC) and relief of lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH) following prostate artery embolization (PAE) in poor surgical candidates.
Patients ineligible for surgical intervention were offered PAE after at least 1 month of IBC for management of urinary retention secondary to BPH; exclusion criteria for PAE included eligibility for surgery, active bladder cancer or known prostate cancer. Embolization technical and clinical success were defined as bilateral prostate embolization and removal of IBC, respectively. Patients were followed for at least 6 months and evaluated for International Prostate Symptom Score, quality of life, prostate size and uroflowmetric parameters.
A total of 43 patients were enrolled; bilateral embolization was performed in 33 (76.7%), unilateral embolization was performed in 8 (18.6%), and two patients could not be embolized due to tortuous and atherosclerotic pelvic vasculature (4.7%). Among the patients who were embolized, mean prostate size decreased from 75.6 ± 33.2 to 63.0 ± 23.2 g (sign rank p = 0.0001, mean reduction of 19.6 ± 17.3%), and IBC removal was achieved in 33 patients (80.5%). Clavien II complications were reported in nine patients (21.9%) and included urinary tract infection (three patients, 7.3%) and recurrent acute urinary retention (six patients, 14.6%). Nine patients (22.0%) experienced post-embolization syndrome.
PAE is a safe and feasible for the relief of LUTS and IBC in highly comorbid patients without surgical treatment options.
KeywordsProstatic artery embolization Acute urinary retention Lower urinary tract symptoms Benign prostatic hyperplasia Indwelling bladder catheterization
Compliance with Ethical Standards
Conflict of interest
SHH and FCC are consultants for Merit Medical Systems, Inc.
- 3.European Association of Urology. Guidelines on the management of non-neurogenic male lower urinary tract symptoms (LUTS), incl. benign prostatic obstruction (BPO) (2014). http://uroweb.org/wp-content/uploads/EAU-Guidelines-Non-Neurogenic-Male-LUTS-Guidelines-2015-v2.pdf. Accessed 4 Mar 2015.
- 4.American Urological Association. Guideline: management of benign prostatic hyperplasia (rev. 2010). https://www.auanet.org/common/pdf/education/clinical-guidance/Benign-Prostatic-Hyperplasia.pdf. Accessed 10 May 2015.
- 8.Antunes AA, Carnevale FC, da Motta Leal Filho JM, Yoshinaga EM, Cerri LMO, Baroni RH, et al. 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. Cardiovasc Interv Radiol. 2013;. doi: 10.1007/s00270-013-0611-5.Google Scholar
- 9.de Assis AM, Moreira AM, de Paula Rodrigues VC, Yoshinaga EM, Antunes AA, Harward SH, et al. Prostatic artery embolization for treatment of benign prostatic hyperplasia in patients with prostates >90 g: a prospective, single-center study. J Vasc Interv Radiol. 2015;26:87–93.CrossRefPubMedGoogle Scholar
- 14.European Association of Urology. Guidelines on reporting and grading of complications after urologic surgical procedures. http://uroweb.org/wp-content/uploads/30-Reporting-complications_LR.pdf. Accessed 1 Dec 2015.
- 18.Silva J, Silva C, Saraiva L, Silva A, Pinto R, Dinis P, et al. Intraprostatic Botulium toxin type A injection in patients unfit for surgery presenting with refractory urinary retention and benign prostatic enlargement: effect on prostate volume and micturition resumption. Euro Urol. 2008;53:153–9.CrossRefGoogle Scholar
- 20.Magno C, Mucciardi G, Gali A, Anastasi G, Inferrera A, Morgia G. Transurethral ethanol ablation of the prostate (TEAP): an effective minimally invasive treatment alternative to traditional surgery for symptomatic benign prostatic hyperplasia (BPH) in high-risk comorbidity patients. Int Urol Nephrol. 2008;40:941–6.CrossRefPubMedGoogle Scholar
- 26.Moreira AM, Marques CFS, Antunes AA, Nahas CSR, Nahas SC, de Gregorio Ariza MA, et al. Transient ischemic rectitis as a potential complication after prostatic artery embolization: case report and review of the literature. Cardiovasc Interv Radiol. 2013;. doi: 10.1007/s00270-013-0739-3.Google Scholar