Abstract No. 446 Prostatic artery embolization with 100μm-300μm particles to treat gross hematuria attributable to benign prostatic hyperplasia: A single-center analysis of 3-year outcomes

Abstract

To present medium-term safety and efficacy data for prostatic artery embolization (PAE) using 100μm-300μm particles to treat gross hematuria attributable to benign prostatic hyperplasia (BPH). 66 patients who underwent PAE with 100μm-300μm particles in the setting of gross hematuria from December 2013 through August 2018 were reviewed retrospectively. Exclusion criteria included technical failure, active urinary infection, and hematuria from other known cause such as stone disease or invasive cancer. 16 patients were treated for severe hematuria (SH) requiring continuous bladder irrigation (CBI), with mean age of 79.8, mean prostate gland volume (PGV) of 326 mL, and mean Charlson comorbidity index (CCI) of 5.8. 39 patients had gross hematuria (GH), but were embolized for treatment of urinary retention (17 patients, mean age of 76.7, mean PGV of 191mL, mean CCI of 4.1), or for lower urinary tract symptoms (LUTS) (22 patients, mean age 74.0, mean PGV of 232mL, mean CCI of 3.8). After undergoing PAE, subjects were evaluated at 1, 3, 6, 12, 24, and 36 months. Adverse events were recorded using the Clavien-Dindo classification. All 55 patients underwent successful PAE. For SH patients, 12/16 (75%) had resolution of hematuria and CBI stopped 2-3 days after PAE, remaining free of gross hematuria with average follow-up of 500 days. 2/16 (19%) SH patients had initial hemostatis but recurrent bleeding requiring fulgaration of prostatic tissue, 52 and 60 days after PAE. 1 patient had recurrent hematuria with urinary infection 165 days after PAE. 1 patient had pink-tinged urine as of 1 month after. For GH patients, 34/37 (92%) remained free of gross hematuria after PAE with mean follow-up of 306 days. They also had excellent improvement in urination, detailed in a separate report. There were 2 deaths <30 days after PAE from coumadin toxicity (unrelated) and urosepsis (grade 5), 7 (13%) grade 2 urinary infections and 5 (9%) self-limited grade 1 adverse events. For patients with either severe hematuria requiring CBI or episodic gross hematuria attributable to benign prostatic hyperplasia, PAE with 100μm-300μm particles is a safe and effective method to treat prostatic hemorrhage1.