Prostatic Artery Embolization Using 100-300-μm Trisacryl Gelatin Microspheres to Treat Lower Urinary Tract Symptoms Attributable to Benign Prostatic Hyperplasia: A Single-Center Outcomes Analysis with Medium-Term Follow-up.

Abstract

To report medium-term outcomes of prostatic artery embolization (PAE) using 100-300-μm trisacryl gelatin microspheres to treat lower urinary tract symptoms (LUTS) from benign prostatic hyperplasia (BPH) and to evaluate how cone-beam computed tomography-measured prostate gland volume (PGV), median lobe enlargement (MLE), age, and Charlson Comorbidity Index (CCI) affect these results. Seventy-four consecutive patients who underwent PAE from April 2014 through August 2018 were retrospectively reviewed. Patients had International Prostate Symptom Score (IPSS) >12, Quality of Life (QoL) score >2, prostate gland volume (PGV) >40 mL, age older than 45 years, and medical therapy failure. Twelve patients were excluded for bladder pathology or prostate cancer. Patients (n= 62, age= 71.8 ± 9.3 years, CCI= 3.5 ± 1.7, PGV= 174 ± 110 mL) had pre-procedure IPSS= 22.4 ± 5.6, QoL score= 4.4±0.9, and post-void residual (PVR)= 172 ± 144 mL. Post-procedure values were compared to baseline at 1, 3, 6, 12, and 24 months. Associations between outcomes and PGV, MLE, age, and CCI were evaluated. Adverse event recording used Clavien-Dindo classification. One month after PAE (n= 37), IPSS improved to 7.6 ± 5.2 (P < .0001) and QoL score improved to 1.7 ± 1.4 (P < .0001). At 3 months (n= 32), improvements continued, with IPSS= 6.4 ± 5.1 (P < .0001), QoL score= 1.2 ± 1.2 (P < .0001), PVR= 53 ± 41 mL (P < .001), and PGV= 73 ± 38 mL (P < .0001). Results were sustained at 6 months (n= 35): IPSS= 6.4 ± 4.1 (P < .0001), QoL score= 1.2 ± 1.2 (P < .0001), PVR= 68 ± 80 mL (P < .0001), PGV= 60 ± 19 mL (P < .001). At 12 months, patients (n= 26) had IPSS= 7.3 ± 5.5 (P < .0001), QoL score= 1.2 ± 0.8 (P <.0001), PVR= 89 ± 117 mL (P < .0001), PGV= 60 ± 48 mL (P < .01). At 24 months, patients (n= 8) had IPSS= 8.0 ± 5.4 (P < .0001), QoL score= 0.7 ± 0.5 (P < .0001), PVR= 91 ± 99mL (P= 0.17), and PGV= 30 ± 5mL (P= .11). Improvements were independent of PGV, MLE, age, and CCI. Two grade II urinary infections occurred. PAE with 100-300-μm microspheres produced sustained substantial improvements in LUTS, PGV, and PVR, which were independent of baseline PGV, MLE, age, or CCI.