Abstract No. 521 Safety and efficacy of coil embolization of the prostate arteries post-particle embolization for lower urinary tract symptoms

Abstract

Prostate artery embolization (PAE) has been historically performed with particles of varying sizes, with coil embolization reserved for preventing nontarget embolization in collateral vessels. Coil embolization of the prostate arteries (PA) has not routinely been performed due to fear of technical complexity if repeat PAE is required. In this study, we present our interim results on the safety and feasibility of coil embolization of PAs after routine particle embolization in PAE. This feasibility study is a retrospective review, totaling 26 male patients who underwent bilateral PAE from September 2018 to August 020. Bilateral particle embolization of PAs to stasis was performed with 100 to 300 μm through a microcatheter. This was followed by coil embolization of the PAs through the microcatheter proximal to the bifurcation of anteromedial and posterolateral branches. Procedural details, pre- and post-procedure International Prostate Symptom Score (IPSS), Quality of Life (QOL), maximum urinary flow rate (Qmax) and adverse events (AE) were recorded. Mean IPSS decreased from 20.7 to 7.7 (↓63%, n = 26, P < 0.001) and mean QOL improved from 4.2 to 1.5 (↓64%, n = 25, P < 0.001) over a mean follow-up period of 10.4 weeks (range, 4–31 weeks, SD 7.6 weeks). 25/26 (96%) patients had reduction in IPSS score. 22/25 (88%) patients had reduction in QOL score. For patients with severe lower urinary tract symptoms (IPSS 20–35), mean IPSS decreased from 26.5 to 8.0 (↓70%, n = 15, P < 0.001) and mean QOL improved from 5.0 to 1.7 (↓67%, n = 14, P < 0.001). Mean Qmax increased from 7.2 to 11.3 (56%, n = 8, P < 0.001). 5/5 patients with hematuria had resolution in short-term follow-up. There was one episode (3.8%) of symptom recurrence for which a repeat PAE was performed. Three AE occurred (11.5%): two glans penis ulceration and one rectal bleeding, which resolved after supportive care, and are most likely attributed to nontarget particle embolization. The use of adjunctive coil embolization following particle embolization in PAE appears to be technically feasible and safe with significant improvement in clinical outcomes in short-term followup. This technique warrants further investigation.