Prostatic Artery Embolization for The Treatment of Benign Prostatic Obstruction - A Retrospective Review of The Novel Experience Of 2 Tertiary Urology Centers

Abstract

Background: Benign Prostatic Hyperplasia (BPH) is common in aging men with worldwide prevalence at 20-62%, while Malaysian prevalence was 39.3% (2001) and increased at 8% per decade. In surgical treatment of BPH, Trans-Urethral Resection of Prostate (TURP) remains the gold standard. Other surgical options would mostly also require general anesthesia (GA). Therefore, more Local-Anaesthesia (LA) based options should be made available for patients who are not fit or unwilling to be under GA. Those currently available LA-based procedure has shown promising results including prostatic stents and trans-urethral lifts, but have drawbacks due to being expensive, not widely available, less suitable in median lobe enlargement or may cause complications including migration, overgrowth of prostatic tissue or foreign-body related complications which may require GA for their treatment. Prostatic Artery Embolization (PAE), initially an LA-based emergency treatment option for persistent life-threatening hematuria from a bleeding BPH, now has been proven to be a safe elective treatment. In Malaysia this novel technique was first reported in 2017 for treatment of post TURP intractable hematuria. Methods and Material: We retrospectively evaluated all 13 catheter-dependent BPH patients in two tertiary urology centres treated with PAE from April 2019 until December 2021 to assess post-treatment efficacy. Results: One patient failed removal of catheter within 3 months post-procedure but 12 out of 13 patients safely got their catheter removed within 1-3 months and resulted in significant IPSS improvement. Conclusion: PAE is a safe and effective treatment option for BPH patients of the Malaysian population but needs prospective evaluation.