Prostatic Artery Embolization (PAE) for Benign Prostatic Hyperplasia (BPH) with Haematuria in the Absence of an Upper Urinary Tract Pathology

  • Charles R. Tapping
  • Andrew Macdonald
  • Mo Hadi
  • Chloe Mortensen
  • Jeremy Crew
  • Andrew Protheroe
  • Mark W. Little
  • Phil Boardman
Clinical Investigation
  • 47 Downloads

Abstract

Purpose

To assess the effectiveness of prostate artery embolization (PAE) in the control of haematuria and in patients with benign prostatic hyperplasia (BPH) and normal upper urinary tracts.

Subjects/Patients

Twelve consecutive patients with haematuria were included in the prospective study. All patients had prior imaging and cystoscopy to exclude other causes of haematuria. Patients prostate arteries were embolized with particles (200–500 μm), and they were followed up at 3, 12 and 18 months following the procedure. QOL questionnaires, IPSS, IIEF and clinical review were all employed to assess the success of the treatment. To allow useful comparison, patients were age- and prostate volume-matched and compared to patients treated with PAE for BPH without haematuria.

Results

All 12/12 cases were technically successful with bilateral PAE being performed. All cases of haematuria resolved by the 3-month follow-up (100%). There was one case of recurrence during the 12-month follow-up (overall clinical success at 18 months 92%). This was due to over anticoagulation and ceased once corrected. There was a reduction in lower urinary tract symptoms noted by improvements in QOL indices, IPSS and IIEF. There was continued success even if the patient was subsequently anticoagulated. There was no associated sexual dysfunction. There was more prostatic arterial branching and volume of embolic required to achieve stasis in BPH and haematuria than in BPH alone (p < 0.05).

Conclusion

PAE is a very useful technique for controlling the quite debilitating condition of haematuria in patients with visible haematuria of prostatic origin. Controlling haematuria and BPH allows a significant improvement in QOL.

Keywords

Prostate artery embolization Haematuria Benign prostatic hyperplasia Lower urinary tract symptoms 

Abbreviations

PAE

Prostatic Artery embolization

LUTS

Lower urinary tract symptoms

BPH

Benign prostatic hyperplasia

IPSS

International prostate symptom score

EQ-5D-5L

Quality of life questionnaire

IIEF

International index of erectile function

PVR

Post-void residual

MRI

Magnetic resonance imaging

CT

Computerized tomography

LAVA

Liver acquisition with acceleration volume

DWI

Diffusion-weighted imaging

STREAM trial

Prospective cohort study of PAE for BPH Oxford, UK

Notes

Acknowledgements

This work was presented as an oral presentation at CIRSE 2017 Copenhagen.

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.

References

  1. 1.
    Pisco JM, Bilhim T, Pinheiro LC, et al. Medium- and long-term outcome of prostate artery embolization for patients with benign prostatic hyperplasia: results in 630 patients. J Vasc Interv Radiol. 2016;27:1115–22.CrossRefPubMedGoogle Scholar
  2. 2.
    Little MW, Boardman P, Macdonald AC, et al. Adenomatous-dominant benign prostatic hyperplasia (AdBPH) as a predictor for clinical success following prostate artery embolization: an age-matched case-control study. Cardiovasc Interv Radiol. 2017;40:682–9.CrossRefGoogle Scholar
  3. 3.
    Chen JW, Shin JH, Tsao TF, et al. Prostatic arterial embolization for control of hematuria in patients with advanced prostate cancer. J Vasc Interv Radiol. 2017;28:295–301.CrossRefPubMedGoogle Scholar
  4. 4.
    Carnevale FC, Soares GR, de Assis AM, Moreira AM, Harward SH, Cerri GG. Anatomical variants in prostate artery embolization: a pictorial essay. Cardiovasc Interv Radiol. 2017;40:1321–37.CrossRefGoogle Scholar
  5. 5.
    Little MW, Macdonald A, Boardman P, et al. Effects of sublingual glyceryl trinitrate administration on the quality of preprocedure CT angiography performed to plan prostate artery embolization. J Vasc Interv Radiol. 2018.  https://doi.org/10.1016/j.jvir.2017.09.019.PubMedGoogle Scholar
  6. 6.
    Tapping CR, Little MW, Boardman P. Treatment of haematospermia with prostatic artery embolization (PAE). J Clin Urol. 2017.  https://doi.org/10.1177/2051415817722935.Google Scholar
  7. 7.
    Bagla S, Smirniotopoulos J, Orlando J, Piechowiak R. Cost analysis of prostate artery embolization (PAE) and transurethral resection of the prostate (TURP) in the treatment of benign prostatic hyperplasia. Cardiovasc Interv Radiol. 2017;40:1694–7.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2018

Authors and Affiliations

  • Charles R. Tapping
    • 1
  • Andrew Macdonald
    • 1
  • Mo Hadi
    • 1
  • Chloe Mortensen
    • 1
  • Jeremy Crew
    • 2
  • Andrew Protheroe
    • 3
  • Mark W. Little
    • 1
  • Phil Boardman
    • 1
  1. 1.Department of RadiologyChurchill HospitalOxfordUK
  2. 2.Department of UrologyChurchill HospitalOxfordUK
  3. 3.Department of OncologyChurchill HospitalOxfordUK

Personalised recommendations