PD41-09 RANDOMIZED CONTROLLED TRIAL COMPARING PROSTATE ARTERY EMBOLIZATION VS OPEN PROSTATECTOMY: CLINICAL AND URODYNAMIC ASSESSMENT IN A ONE YEAR FOLLOW UP

Abstract

You have accessJournal of UrologyCME1 Apr 2023PD41-09 RANDOMIZED CONTROLLED TRIAL COMPARING PROSTATE ARTERY EMBOLIZATION VS OPEN PROSTATECTOMY: CLINICAL AND URODYNAMIC ASSESSMENT IN A ONE YEAR FOLLOW UP Bruno Lebani, André Silva, Eduardo Silveira, Milton Skaff, and Fernando Almeida Bruno LebaniBruno Lebani More articles by this author , André SilvaAndré Silva More articles by this author , Eduardo SilveiraEduardo Silveira More articles by this author , Milton SkaffMilton Skaff More articles by this author , and Fernando AlmeidaFernando Almeida More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003346.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The Open Prostatectomy (OP) remains one of the gold standard treatments for Benign prostate enlargement larger than 80 ml. The Prostate Artery embolization (PAE) is a minimally invasive procedure that interrupts the blood flow, shrinking the prostatic adenoma. There is no randomized controlled trials assessing PAE for prostates larger than 80 ml in patients with bladder outlet obstruction (BOO) and good detrusor function. The aim of this study is to evaluate PAE in prostates larger than 80 ml, comparing the results to patients underwent to open prostatectomy. METHODS: A non-inferiority, randomized, open label-controlled trial was developed in a single center, between January 2020 and May 2022. OP was indicated according to prostate weight (larger than 80 ml measured by MRI) and symptoms, urodynamics parameters meeting Bladder Outlet Obstruction (defined by BOOI >40) and good detrusor function (defined by Bladder contractility index - BCI >100). The patients were randomized to OP and PAE. The primary endpoint was urodynamic comparisons, embracing changes on Maximum urinary flow rate in pressure-flow studies (Qmax-QxP), Detrusor pressure at maximum flow rate (PdetQmax) and Bladder outlet obstruction index (BOOI) from baseline to 6 months. Secondary endpoints include clinical assessment, laboratory and ultrasonography . Analyses between groups of all schedule visits at 1, 3, 6 and 12 months were performed. RESULTS: 23 patients were evaluated in PAE arm and 25 were evaluated in OP arm. Groups are similar, without differences in clinical, radiological or urodynamic parameters. In baselinte, PAE group presented Qmax of 3,78±3,32, IPSS of 27,4±5,65, BOOI of 93,7±30,9 and BCI of 128±25,3. OP presented Qmax of 3,78±3,32, IPSS of 30±4,95, BOOI of 116±53,8 and BCI of 147±50,4. After 6 months, both groups presented significant improvement in Qmax compared to their respective baseline (8,3±4,17 for PAE group vs 15,1±8,04 for OP group), nonetheless the effectiveness was greater in OP arm, with a statistical difference reaching 7.8 ml/second. The decrease from baseline to month 6 in PDetQmax was lower in PAE than in OP group, despite Qmax improvement (-5,17 vs -79,92 cm H2O). Similar findings were observed in BOOI (PAE – 9,03 vs OP -95 cm H2O, p<0,001). It was observed a large reduction in IPSS (more than 15 points) in both groups, with no difference between them. CONCLUSIONS: Both procedures resulted in significant clinical improvements in the treatment of BPH. However, PAE is inferior compared to OP, assessing urodynamic parameters. Source of Funding: No © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1062 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Bruno Lebani More articles by this author André Silva More articles by this author Eduardo Silveira More articles by this author Milton Skaff More articles by this author Fernando Almeida More articles by this author Expand All Advertisement PDF downloadLoading ...