Efficacy of Prostatic Artery Embolization for Catheter-Dependent Patients with Large Prostate Sizes and High Comorbidity Scores

Abstract

PurposeTo evaluate efficacy and safety of prostate artery embolization (PAE) in urinary catheter–dependent patients with large prostate volumes and high comorbidity scores. Materials and MethodsA retrospective single-center review was conducted of 30 patients with urinary retention at time of PAE from November 2014 through February 2017. Mean (range) age was 73.1 years (48–94 y), age-adjusted Charlson comorbidity index was 4.5 (0–10), duration of urinary retention was 63.4 days (2–224 d), International Prostate Symptom Score quality-of-life (IPSS-QOL) was 5.3 (3–6), and prostate volume was 167.3 cm3 (55–557 cm3). These parameters were collected at 3, 6, and 12 months after PAE. Trials of voiding were performed approximately 2 weeks after PAE and, if failed, every 2 weeks thereafter. Adverse events were graded using the Clavien-Dindo classification. ResultsAt a mean (range) of 18.2 days (1–72 d), 26 (86.7%) patients were no longer reliant on catheters. Follow-up was obtained in all patients eligible at 3 and 6 months and 17 of 20 (85.0%) patients eligible at 1 year. Mean (range) IPSS-QOL improved significantly to 1.2 (0–5), 0.7 (0–4), and 0.6 (0–4) at 3, 6, and 12 months (all P < .001). Mean (range) prostate volume decreased significantly to 115.9 cm3 (27–248 cm3) at 3 months (P < .001). Two patients experienced grade II urosepsis complications, which were successfully treated with intravenous antibiotics. All other complications were self-limited grade I complications. ConclusionsPAE represents a safe and effective option for management of patients with urinary retention, especially patients with large prostates who are not ideal surgical candidates.