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Interventionelle Therapie der benignen Prostatahyperplasie

Embolisation der V. spermatica

Interventional treatment of benign prostatic hyperplasia

Embolization of the testicular vein

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Zusammenfassung

Klinisches/methodisches Problem

Als interventionelles Verfahren zur Behandlung der benignen Prostatahyperplasie (BPH) wird die Embolisation der Vv. spermaticae (Gat-Goren-Technik) diskutiert.

Radiologische Standardverfahren

Neben urologischen Standardeingriffen wie z. B. der transurethralen Prostataresektion (TUR-P) gilt die arterielle Embolisation der Prostata bisher als interventionell-radiologisches Verfahren der Wahl.

Methodische Innovationen

Die Embolisation der Vv. spermaticae entspricht technisch einer Varikozelenembolisation bei infertilen Männern und stellt eine wenig invasive Behandlungsmethode dar.

Leistungsfähigkeit

Die Embolisation kann als risiko- und nebenwirkungsarmes Verfahren durchgeführt werden. Varianten der venösen Anatomie können den Eingriff erschweren. In aktuellen Studien wird im mittelfristigen Verlauf von einer guten Symptomreduktion berichtet.

Bewertung

Obwohl mittelfristige Ergebnisse vielversprechend sind, fehlen bisher Daten zu Langzeitergebnissen und Vergleiche zu alternativen Behandlungsmethoden.

Empfehlung für die Praxis

Die Embolisation der Vv. spermaticae zur Behandlung der BPH stellt eine wenig invasive Methode dar. Der Eingriff kann ambulant oder tagesstationär durchgeführt werden. Im mittelfristigen Verlauf bis 6 Monate nach dem Eingriff zeigen sich in bisher durchgeführten Untersuchungen zufriedenstellende Ergebnisse. Randomisierte Studien, Daten zu Langzeitergebnissen und Vergleiche zu alternativen Methoden (z. B. arterielle Prostataembolisation, operative Verfahren) fehlen bisher.

Abstract

Clinical/methodical issue

Embolization of the testicular veins (Gat-Goren technique) is an interventional procedure for the treatment of benign prostatic hyperplasia (BPH).

Standard radiological methods

In addition to standard urological procedures, such as transurethral resection of the prostate (TUR-P), arterial embolization of the prostate is considered as the interventional radiological method of choice.

Methodical innovations

Embolization of the testicular veins is technically identical to the embolization of varicoceles in infertile men and represents a less invasive treatment.

Performance

Embolization of the testicular veins can be performed as a low-risk intervention with low side effects. Variants of the venous anatomy can make the procedure more difficult. In current studies a good reduction of symptoms could be achieved in intermediate-term follow-up.

Achievements

The medium-term results are promising but data on long-term results and comparisons with alternative treatments are missing.

Practical recommendations

Embolization of the testicular veins is a minimally invasive method for the treatment of BPH. The procedure can be performed in an outpatient setting. In the intermediate course up to 6 months after treatment, promising results were demonstrated in recent studies. Randomized studies, data on long-term results and comparisons to alternative methods (e. g. arterial prostatic embolization and surgical procedures) are missing.

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Authors and Affiliations

  1. Radiologische Klinik, Universitätsklinikum Bonn, Sigmund-Freud-Straße 25, 53127, Bonn, Deutschland

    M. Rauch & H. Strunk

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  1. M. Rauch
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  2. H. Strunk
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Correspondence to M. Rauch.

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M. Rauch und H. Strunk geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Rauch, M., Strunk, H. Interventionelle Therapie der benignen Prostatahyperplasie. Radiologe 57, 652–658 (2017). https://doi.org/10.1007/s00117-017-0275-2

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