Abstract No. 689 Prostate artery embolization in patients with prior transurethral resection of the prostate: a feasibility study

Abstract

This study examines the feasibility of prostate artery embolization (PAE) as a treatment for benign prostatic hyperplasia (BPH) with refractory lower urinary tract symptoms (LUTS) after transurethral resection of the prostate (TURP). The feasibility of PAE to treat refractory BPH-associated LUTS in patients with prior TURP has not been established. PAE cases from April 2015 through June 2019 at two hospitals in a tertiary academic health system were queried (n = 159). Patients were included if they underwent elective PAE and had at least one prior TURP (n = 10). Patients undergoing emergent PAE for hematuria were excluded. Demographic, baseline, procedural, and follow-up data were collected where available for consecutive patients meeting the inclusion criteria. Technical success was defined as bilateral stasis. Patients studied had a mean age of 72.5 years (SD = 5.7) and ellipsoid prostate volumes of 131.1 cm3 (range, 54-196 cm3). The median time between most recent TURP and PAE was 7 years (range, 1-15 years). 7 patients had 1 prior TURP, 2 had 2, and 1 had 3. Mean baseline International Prostate Symptom Score (IPSS) was 20.2 (SD = 9.6) and mean Quality of Life score (QOL) was 4.4 (SD = 1.6). Procedures had a mean fluoroscopy time of 37.5 minutes, radiation dose of 647583.2 mGycm2, and contrast volume of 142 mL. Technical success was achieved in 8 of 10 patients. In the other 2 patients, unilateral stasis was achieved. One failure was unilateral due to excessive fluoroscopy time and one was due to inability to visualize the left prostatic artery. After an average of 70.8 days (SD = 88) post-PAE, mean IPSS reduction was 4.9 (n = 7, SD = 5.0, P = 0.03) and mean QOL reduction was 0.5 (n = 6, SD = 0.5, P = 0.04). Post-PAE adverse events included urethral irritation (n = 1), pain (n = 1), and incomplete emptying with a need for self-catheterization (n = 1). While more research is required to fully assess efficacy and safety, preliminary results in a group of 10 patients indicate feasibility of PAE as a promising treatment option in patients with BPH-associated refractory LUTS post-TURP.