Unilateral versus bilateral prostatic arterial embolization in patients with benign prostatic hyperplasia

• Published in: Journal of vascular and interventional radiology Vol. 24; no. 4; p. S74
• Main Authors: Bilhim, T, Pisco, J.M, Rio Tinto, H, Fernandes, L, Pereira, J, Duarte, M, Campos Pinheiro, L, Oliveira, A, O'Neill, J.E
• Format: Journal Article
• Language: English
• Published: 01.04.2013
• Subjects: Radiology
• ISSN: 1051-0443
• DOI: 10.1016/j.jvir.2013.01.175

Purpose To compare baseline data and clinical outcome between patients with Prostate Enlargement/Benign Prostatic Hyperplasia (PE/BPH) who underwent unilateral and bilateral Prostatic Arterial Embolization (PAE) for the relief of Lower Urinary Tract Symptoms (LUTS). Materials and Methods Single center ambispective cohort study in 122 consecutive patients (mean patient age 66.7 years) comparing patients with unilateral versus bilateral PAE (March 2009 - September 2011). Selective PAE with 100 μm and 200 μm nonspherical polyvinyl alcohol (PVA) particles. The outcome of PAE was evaluated by International Prostate Symptom Score (IPSS), Quality of Life (QoL) and International Index of Erectile Function (IIEF) measurements, prostate volume (PV) reduction, PSA, Peak Urinary Flow-rate (Qmax) and Post-void Residual Volume (PVR) measurements. Poor outcome after PAE considered when 1 criteria was met: IPSS ≥ 20 and/or reduction < 25%; QoL ≥ 4 and/or reduction < 1; Additional treatments required. Results Mean follow-up 7.1 months (range 3 - 12 months). Group A - Bilateral PAE - 103 (84.4%) patients; Group B - Unilateral PAE - 19 (15.6%) patients. Patients from Group B were significantly older (mean age 71.3 ± 1.7 years, p=0.002), the remaining baseline parameters did no differ significantly. Mean PV reduction of 18.2 mL (19.2%, p<0.0001); Mean PSA reduction of 1.73 ng/mL (30.9%, p<0.0001); Mean IPSS/QoL improvement of 11.3 /1.93 points (44.8%/44.2%, p<0.0001); Mean Qmax improvement of 4.00 mL/s (65.0%, p<0.0001) Mean PVR reduction of 35.9 mL (0,5%, p=0.002); IIEF improved 1.55 points (23.6%, p=0.017). In Group A PV volume reduced more 7.9 mL; IPSS reduced more 2.9 points and the QoL 0.6 points (p>0.05). PSA, Qmax and PVR improvements after PAE did not differ significantly between groups. Poor clinical outcome: Group B 47.4%; Group A 24.3% (23.1% difference, p=0.04). Conclusion PAE is a challenging technique with up to 15% of patients with unilateral embolization. PAE is safe and effective inducing 45% improvement in the IPSS score and a prostate volume reduction of 18%. Bilateral PAE is associated with better clinical results. Up to 50% of patients with unilateral PAE may have a good clinical outcome.