Polyvinyl alcohol particle size for prostatic artery embolization: a prospective randomized study of 100 μm particles versus 200 μm particles

Abstract

Purpose Evaluate whether different polyvinyl alcohol (PVA) particle sizes change the outcome of prostatic artery embolization (PAE) for Benign Prostatic Hyperplasia (BPH). Materials and Methods Randomized prospective study, 80 patients with BPH undergoing PAE (May - December 2011). PAE was performed with 100 μm particles in 40 patients (Group A); and 200 μm particles in 40 patients (Group B). Pain was measured (0 - 10) during PAE, after 4-8 hours and the week following PAE. Complication rates were compared. The outcome of PAE was evaluated by IPSS, QoL and IIEF measurements, prostate volume reduction, PSA, Qmax and PVR measurements at 3 and 6 months. Results Patients lost to follow-up: 2 (Group A); 5 (Group B). Mean baseline data between groups (age; prostate volume; PSA; IPSS/QoL; Qmax; post-void residual volume; acute urinary retention rate): 64.4 years; 78.4 mL; 5.4 ng/mL; 22.5/4.7 points; 8.1 mL/s; 106.8 mL; 7.9% (n=3) in Group A; 63.9 years; 81.9 mL; 9.0 ng/mL; 22.3/4.3 points; 10.2 mL/s; 90.9 mL; 8.6% (n=3) in Group B. Mean PVA volume used: 0.33cc in Group A; 0.4cc in Group B. Unilateral PAE - 18.4% (n=7) in Group A; 22.9% (n=8) in Group B. Mean pain scores during embolization: 3.3 (group A); 3.3 (group B); after embolization, mean pain scores: 0.1 (group A) and 0 (group B). There were no statistically significant differences in the minor complication rates, with no major complications. Mean IPSS/QoL reduction: 6.0/1.7 (Group A); 10.7/1.9 (Group B); mean prostate volume reduction: 14.7% (Group A); 6% (Group B). Poor clinical outcome: 47.4% (n=18, Group A); 25.7% (n=9, Group B); p=0.04. Conclusion No significant differences were noted in pain severity or complication rates after PAE for BPH using 100 μm or 200 μm PVA particles. The clinical outcome at 3 and 6 months was significantly better with 200 μm PVA particles, but there was a greater prostate volume and PSA reduction with 100 μm PVA particles.