Patient Selection and Counseling before Prostatic Arterial Embolization

• Published in: Techniques in vascular and interventional radiology Vol. 15; no. 4; pp. 270 - 275
• Main Authors: A. Pereira, José, MD, Bilhim, Tiago, MD, PhD, EBIR, Duarte, Marisa, MD, Rio Tinto, Hugo, MD, Fernandes, Lúcia, MD, Martins Pisco, João, MD, PhD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.12.2012
• Subjects: benign prostatic hyperplasia (BPH); clinical assessment; Counseling; Embolization, Therapeutic - adverse effects; Hematology, Oncology and Palliative Medicine; Humans; inclusion and exclusion criteria; Lower Urinary Tract Symptoms - etiology; Male; Patient Selection; Predictive Value of Tests; Prostate - blood supply; prostatic arterial embolization (PAE); Prostatic Hyperplasia - complications; Prostatic Hyperplasia - diagnosis; Prostatic Hyperplasia - physiopathology; Prostatic Hyperplasia - therapy; Radiology; Risk Factors; Severity of Illness Index; Treatment Outcome; Urodynamics; Workflow; benign prostatic hyperplasia (BPH); inclusion and exclusion criteria; clinical assessment; prostatic arterial embolization (PAE)
• ISSN: 1089-2516; 1557-9808
• DOI: 10.1053/j.tvir.2012.09.003

Prostatic arterial embolization (PAE) for relief of lower urinary tract symptoms (LUTS) in patients with prostate enlargement or benign prostatic hyperplasia (PE or BPH) is an experimental procedure with promising preliminary results. Patient evaluation and selection before PAE is paramount to improve technical and clinical results. Our inclusion criteria for PAE include: male patients, age>40 years, prostate volume>30 cm3 and diagnosis of PE or BPH with moderate to severe LUTS refractory to medical treatment for at least 6 months (International Prostate Symptom Score [IPSS]>18, or quality of life [QoL]>3, or both) or with acute urinary retention refractory to medical therapy. Exclusion criteria include: malignancy (based on pre-embolization digital rectal and transrectal ultrasound [TRUS] examinations and prostate specific antigen [PSA] measurements with positive biopsy), large bladder diverticula, large bladder stones, chronic renal failure, tortuosity and advanced atherosclerosis of a) iliac or b) prostatic arteries on pre-procedural computed tomographic angiography (CTA), active urinary tract infection and unregulated coagulation parameters. Approximately one-third of the patients seen initially on consultation satisfy the criteria to be selected for PAE after undergoing the pre-procedural patient evaluation workflow. In the pre-procedural consultation patients are informed of all possible therapeutic options for LUTS with the investigational nature of the procedure being strongly reinforced. The major advantage of PAE relies on the minimally-invasive nature of the technique with minimal morbidity and rapid recovery,and it being performed as an outpatient procedure. However, the experimental nature and uncertain clinical outcome should also be weighed before opting for PAE. All these considerations should be explained to the patient and discussed during the informed consent before PAE.