Abstract
ObjectiveTo describe the efficacy and safety of protective embolization during prostatic artery embolization, as well as to discuss its clinical relevance.Materials and MethodsThis was a retrospective, observational, single-center study including 39 patients who underwent prostatic artery embolization to treat lower urinary tract symptoms related to benign prostatic hyperplasia between June 2008 and March 2018. Follow-up evaluations, performed at 3 and 12 months after the procedure, included determination of the International Prostate Symptom Score, a quality of life score, and prostate-specific antigen levels, as well as ultrasound, magnetic resonance imaging, and uroflowmetry.ResultsProtective embolization was performed in 45 arteries: in the middle rectal artery in 19 (42.2%); in the accessory internal pudendal artery in 11 (24.4%); in an internal pudendal artery anastomosis in 10 (22.2%); in the superior vesical artery in four (8.9%); and in the obturator artery in one (2.2%). There was one case of nontarget embolization leading to a penile ulcer, which was attributed to reflux of microspheres to an unprotected artery. There were no complications related to the protected branches. All of the patients showed significant improvement in all of the outcomes studied (p < 0.05), and none reported worsening of sexual function during follow-up.ConclusionProtective embolization can reduce nontarget embolization during prostatic artery embolization without affecting the results of the procedure. In addition, no adverse events other than those expected or previously reported were observed. Therefore, protective embolization of pudendal region is safe.
Highlights
Prostatic artery embolization (PAE) as a treatment for benign prostatic hyperplasia (BPH) was first reported by DeMeritt et al[1] in a patient with refractory hematuria
Microcoils were deployed in the middle rectal artery (Figure 1) in 19 (42.2%) of the 45 cases of occluded arteries; in the accessory internal pudendal artery (Figure 2) in 11 (24.4%); in an internal pudendal artery anastomosis in 10 (22.2%); in the distal superior vesical artery in four (8.9%); and in the distal obturator artery in one (2.2%)
All of the patients in our sample showed statistically significant improvements in all of the parameters analyzed. These results suggest that Protective embolization (PE) does not negatively affect the results of PAE, possibly because of the very distal navigation into the anastomosis during PE, which prevented blockage of prostatic artery branches
Summary
Prostatic artery embolization (PAE) as a treatment for benign prostatic hyperplasia (BPH) was first reported by DeMeritt et al[1] in a patient with refractory hematuria. Pilan BF, et al / Protection of nontarget structures in PAE due to BPH, showing it to be a viable treatment alternative. Studies have established PAE as a safe, effective treatment, showing it to be associated with a significant reduction in prostate size and in elasticity, which leads to better functional and clinical outcomes[3,4,5,6,7]. Knowledge of the vascular anatomy of the prostate and its variations, as well as a meticulous analysis during the procedure, is crucial because misinterpretation of the anatomy could result in nontarget embolization (NTE) of periprostatic organs and structures such as the bladder, rectum, and penis[12]. Protective embolization (PE) of nontarget arteries or extraprostatic anastomoses, typically using coils or gelatin sponges, can be performed to redirect blood flow to the prostatic artery and avoid NTE. The impact that PE of the internal pudendal artery branches and the accessory internal pudendal artery has on sexual function is a matter of concern
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