Prostate Embolization as an Alternative to Open Surgery in Patients with Large Prostate and Moderate to Severe Lower Urinary Tract Symptoms

• Published in: Journal of vascular and interventional radiology Vol. 27; no. 5; pp. 700 - 708
• Main Authors: Pisco, João, MD, PhD, Bilhim, Tiago, MD, PhD, EBIR, Pinheiro, Luis C., MD, PhD, Fernandes, Lúcia, MD, Pereira, José, MD, Costa, Nuno V., MD, Duarte, Marisa, MD, Oliveira, António G., MD, PhD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.05.2016
• Subjects: Aged; Aged, 80 and over; Computed Tomography Angiography; Embolization, Therapeutic - adverse effects; Embolization, Therapeutic - methods; Humans; Lower Urinary Tract Symptoms - diagnosis; Lower Urinary Tract Symptoms - etiology; Male; Middle Aged; Portugal; Prostatic Hyperplasia - complications; Prostatic Hyperplasia - diagnostic imaging; Prostatic Hyperplasia - therapy; Quality of Life; Radiology; Recovery of Function; Retrospective Studies; Severity of Illness Index; Time Factors; Treatment Outcome; PV; PVR; QoL; Q max; acute urinary retention; HoLEP; lower urinary tract symptoms; International Index of Erectile Function; AUR; benign prostatic hyperplasia; PSA; IIEF; holmium laser enucleation of the prostate; IPSS; CI; prostate volume; LUTS; prostate artery embolization; postvoid residual urine volume; PAE; polyvinyl alcohol; confidence interval; PVA; BPH; quality of life; peak urinary flow rate; International Prostate Symptom Score; prostate-specific antigen; Qmax
• ISSN: 1051-0443; 1535-7732
• DOI: 10.1016/j.jvir.2016.01.138

Abstract Purpose To evaluate efficacy of prostate artery embolization (PAE) in patients with benign prostatic hyperplasia (BPH), prostate volume (PV) > 100 cm3. Materials and Methods This was a single-center retrospective cohort study. Between March 2009 and September 2014, PAE was performed in patients with a diagnosis of BPH, PV > 100 cm3 , and moderate to severe lower urinary tract symptoms (LUTS) refractory to medical treatment for at least 6 months or who had acute urinary retention. Success was defined as improved symptoms (International Prostate Symptom Score ≤ 15 and decrease of ≥ 25% from baseline score), improved quality of life (measured as score of ≤ 3 points or decrease of ≥ 1 point from baseline), and no need for additional treatment. Results PAE was performed in 152 patients 48–87 years old (mean ± SD 67.4 y ± 7.5) with mean PV of 134.2 cm3 ± 41.8 (range, 101–383 cm3 ). PAE was technically successful in 149 patients (98.0%). Symptomatic control was achieved for a median of 18 months ± 15.5 (range, 3–66 mo). There were 33 clinical failures (23.6%); 23 occurred in the short-term (≤ 6 mo), and 10 occurred in the medium-term (6–24 mo); there were no long-term failures (> 36 mo). Cumulative clinical success rates were 90%, 87.9%, 83.5%, 81.1%, and 77.8% at 1, 3, 6, 12, and 18 months and 72.4% thereafter to 66 months (5.5 y). Conclusions PAE provides sustained short-, medium-, and long-term control for LUTS in patients with BPH and PV > 100 cm3.