Selective arterial embolization as minimally invasive method of treatment of benign prostatic hyperplasia in patients with high operative risk

Abstract

Background : The choice of method of treatment of benign prostatic hyperplasia (BPH) in elderly patients with high operative risk is one of the pressing issues of modern urology. Selective arterial embolization (SAE) of the prostate – is a new method of treating lower urinary tract symptoms caused by benign prostatic hyperplasia. Materials and Method: 21 male patients with prostate volume larger than 40 ml, contraindications for traditional operations on the prostate, high level of operative-anesthesiological risk (III-IV on American Society of Anaesthesiologists scale) and normal PSA levels underwent SAE procedure under local anesthesia from one surgical approach through the right femoral artery. Patient`s levels of PSA total were monitored, a digital rectal examination was performed and an ultrasound investigation of the prostate was conducted, maximum urinary flow (Qmax) was measured, IPSS index and quality of life (QoL) subscore were determined. Results and discussion: The intervention was performed successfully in 19 patients (90,5%). Subsequent examination revealed significant improvement of IPSS on average by 12 points and QoL levels on average by 3 points, reduction of the volume of the prostate at mean by 35%, and increase of maximal urine flow at mean by 32%. First signs of clinical improvement were observed one week after the intervention. No significant complications connected to angiography or embolization, which needed surgery or long-term hospitalization, were registered. Conclusion : Our preliminary experience suggests that SAE is safe and effective for treatment of symptomatic BPH in elderly patients who have contraindications to traditional operations and high operative risk.