03:09 PM Abstract No. 4 Prostatic artery embolization with 100- to 300-μm particles to treat lower urinary tract symptoms attributable to benign prostatic hyperplasia: a single-center analysis of 2-year outcomes

Abstract

To present medium-term safety and efficacy data for prostatic artery embolization (PAE) using 100- to 300-μm particles to treat lower urinary tract symptoms (LUTS) caused by benign prostatic hyperplasia (BPH). 74 patients who underwent PAE with 100μm-300μm particles from April 2014 through August 2018 were retrospectively reviewed. Exclusion criteria were dementia preventing symptom evaluation and technical failure. Subjects (n=60, mean age=71.4, mean Charlson comorbidity index=3.3, mean prostate gland volume (PGV)=183mL) had a mean pre-procedure International Prostate Symptom Score (IPSS) of 21.5, mean Quality of Life score (QOL) 4.3, and mean post-void residual (PVR) 163mL. After PAE, subjects were evaluated at 1, 3, 6, 12 and 24 months. Comparisons to baseline values used T-tests (PGV, PVR) or Wilcoxon signed rank tests (IPSS, QOL). Adverse events were recorded using the Clavien-Dindo classification. One month after PAE, mean IPSS dropped from 21.5 to 7.7 (↓64%) and mean QOL improved from 4.3 to 1.8 (↓58%) (n=42, P<0.001 for both). At 3 months, there was further improvement: mean IPSS was 6.2 (↓71%) and mean QOL 1.1 (↓74%); also mean PVR was 64mL (↓61%) and mean PGV 62mL (↓66%) (n=34, P<0.001 for all). At 6 months, results were sustained with mean IPSS of 6.3 (↓71%), mean QOL 1.1 (↓74%), mean PVR 61mL (↓63%), and mean PGV 75mL (↓59%) (n=41, P<0.001 for all). At 12 months, mean IPSS was 6.7 (↓69%), mean QOL 1.0 (↓77%), mean PVR 64mL (↓61%), and mean PGV 71mL (↓62%) (n=29, P<0.001 for all). At 24 months (n=8), mean IPSS was 7.8 (↓64%, P<0.001), mean QOL 0.6 (↓86%, P<0.001), mean PVR 89mL (↓45%, P=NS), and mean PGV 44mL (↓76%, P=NS). Two significant adverse events occurred: one urinary tract infection (grade 2) and one case of painful necrotic tissue that was transurethrally resected (grade 3B). Ten (17%) self-limited grade 1 adverse events occurred. PAE with 100- to 300-μm particles produced sustained significant improvements in LUTS, PVR, and PGV in the range of transurethral procedures. Safety was similar and efficacy superior to most PAE series using larger size particles. PAE is a viable option for patients who are not good surgical candidates.