Efficacy Of Prostatic Artery Embolization Research Articles

Prostate Embolization as an Alternative to Open Surgery in Patients with Large Prostate and Moderate to Severe Lower Urinary Tract Symptoms

PurposeTo evaluate efficacy of prostate artery embolization (PAE) in patients with benign prostatic hyperplasia (BPH), prostate volume (PV) > 100 cm3. Materials and MethodsThis was a single-center retrospective cohort study. Between March 2009 and September 2014, PAE was performed in patients with a diagnosis of BPH, PV > 100 cm3, and moderate to severe lower urinary tract symptoms (LUTS) refractory to medical treatment for at least 6 months or who had acute urinary retention. Success was defined as improved symptoms (International Prostate Symptom Score ≤ 15 and decrease of ≥ 25% from baseline score), improved quality of life (measured as score of ≤ 3 points or decrease of ≥ 1 point from baseline), and no need for additional treatment. ResultsPAE was performed in 152 patients 48–87 years old (mean ± SD 67.4 y ± 7.5) with mean PV of 134.2 cm3 ± 41.8 (range, 101–383 cm3). PAE was technically successful in 149 patients (98.0%). Symptomatic control was achieved for a median of 18 months ± 15.5 (range, 3–66 mo). There were 33 clinical failures (23.6%); 23 occurred in the short-term (≤ 6 mo), and 10 occurred in the medium-term (6–24 mo); there were no long-term failures (> 36 mo). Cumulative clinical success rates were 90%, 87.9%, 83.5%, 81.1%, and 77.8% at 1, 3, 6, 12, and 18 months and 72.4% thereafter to 66 months (5.5 y). ConclusionsPAE provides sustained short-, medium-, and long-term control for LUTS in patients with BPH and PV > 100 cm3.

Prostatic Artery Embolization and its Efficacy in the Reduction of Nocturia

Introduction: Nocturia is a major problem in men with lower urinary tract symptoms(LUTS) and Benign Prostatic Hyperplasia (BPH). Transurethral resection of the prostate (TURP) and photoselective vaporization (PVP) have been shown to reduce nocturnal frequency in 32.2% of patients by 0.8 to 1.0 episodes per night, though they carry the risk of operative morbidity. We report on the efficacy of prostatic artery embolization (PAE) in the reduction of nocturia. Materials & Methods: IRB-approved retrospective study was performed of sixty-eight PAE patients performed in two U.S. centers (Site 1 n=40, Site 2 n=28). American Urological Association symptom index (AUA-SI), quality of life-related symptoms (QoL), nocturnal frequency were evaluated at baseline and at one and three-months. A paired t-test was performed to assess significance. Results: Baseline demographics demonstrated mean age 64.5 years, AUA-SI 23.9, QoL 4.8, PV 80.6 cc, and Nocturnal Frequency 3.3 episodes. 54.4% (25/46) of patients reported improvement in nocturnal frequency at 1 month and 73.7 % (28/38) at 3 months. Absolute reduction of 0.82 and 1.56 episodes per night were reported at 1 and 3 months (p<0.0001). AUA-SI decreased by 10.0 and 13.4 points at 1 and 3 months (p<0.0001). Quality of Life improved by 2.1 and 2.8 points at 1 and 3 months (p<0.0001). Ten minor self-limiting complications were observed. No major complications were reported. Conclusions: PAE significantly reduced nocturnal frequency in more than 70% of patients at 3 months.

Intra-vesical Prostatic Protrusion (IPP) Can Be Reduced by Prostatic Artery Embolization.

Prostate artery embolization (PAE) is a new approach to improve lower urinary tract symptoms (LUTS) related to benign prostatic hyperplasia. PAE results in global reduction of prostate volume (PV). There are no data available on the efficacy of PAE in reducing intra-vesical prostatic protrusion (IPP), an anatomic feature that is clinically related with bladder outlet obstruction and LUTS. To assess the results of PAE in patients with significant IPP due to median lobe hyperplasia and to compare the IPSS decrease and IPP change. Prospective analysis of 18 consecutive patients with significant IPP (>5 mm) related to median lobe hyperplasia undergoing PAE using 30-500-μm-calibrated trisacryl microspheres. We measured IPP on sagittal T2-weighted images before and 3 months after PAE. IPSS and clinical results were also evaluated at 3 months. PAE resulted in significant IPP reduction (1.57 cm ± 0.55 before PAE and 1.30 cm ± 0.46 after PAE, p = 0.0005) (Fig. 1) with no complication. IPSS, quality of life (QoL), total prostate-specific antigen (PSA) level, and PV showed significant reduction after PAE, and maximum urinary flow rate (Q max) showed significant increase after PAE. No significant change of International Index of Erectile Function (IIEF) for clinical evaluation after PAE. A significant correlation was found between the IPP change and the IPSS change (r = 0.636, p = 0.0045). Patients had significant IPP reduction as well as significant symptomatic improvement after PAE, and these improvements were positively correlated.

3:39 PM, Abstract No. 297 - Short- to mid-term safety and efficacy of prostatic artery embolization: a systematic review

3:39 PM, Abstract No. 297 - Short- to mid-term safety and efficacy of prostatic artery embolization: a systematic review

Safety and Efficacy of Prostate Artery Embolization in Small-Volume Benign Prostatic Hyperplasia

Purpose Traditional urologic surgery of small-volume benign prostatic hyperplasia (BPH) is associated with high failure rates and complications such as bladder neck strictures and contractures. While prostate artery embolization (PAE) is postulated to be effective secondary to gland size reduction, we hypothesize that it may be equally effective in patients with small volume glands. We present our experience of PAE in prostate sizes Material and Methods An Institutional Review Board approved a retrospective study of 78 consecutive PAE patients from January 2011 to July 2014. Patients were evaluated at baseline, 1, 3, and 6 months with the American Urological Association (AUA-SI) symptom index including quality of life-related symptoms (QoL), International Index of Erectile Function (IIEF), and prostate imaging (magnetic resonance imaging, ultrasound, or computed tomography at baseline). Analysis was performed for each stratified group (Group 1, prostate volume 50 cc) individually from baseline to 1, 3, and 6 months and between groups at each follow-up to assess for differences in outcome. Results There were no significant differences in baseline age, AUA score, QoL, or IIEF between groups (mean age 65.2 years, 26.4 AUA, 4.9 Qol, 14 IIEF; n = 78). Baseline volumes were: group 1 (37.5 cc, 25.9 to 48.0 cc, n = 16) and group 2 (108.5 cc, 52.0 to 274.0 cc, n = 62 }. Technical success was achieved in 16/16 patients in Group 1 and 59/62 in Group 2, with 2 unilateral embolizations and 1 unsuccessful secondary to bilateral atherosclerotic occlusion in the latter group. A statistically significant reduction in AUA was achieved in both groups from baseline to 1, 3 and 6 months (n = 77): Group 1: Baseline 27.2 to 12.7, 12.0, and 11.2 at 1, 3, and 6m (p Conclusions PAE appears to offer similar positive clinical benefits to 6 months in patients with small-volume BPH. This may offer crucial benefit to those patients with limited surgical options. Future study aimed at evaluating recurrence rates is suggested.

Prostatic Artery Embolization for Treatment of Benign Prostatic Hyperplasia in Patients with Prostates > 90 g: A Prospective Single-Center Study

PurposeTo describe the safety and efficacy of prostatic artery embolization (PAE) with spherical microparticles to treat lower urinary tract symptoms associated with benign prostatic hyperplasia in patients with prostate volume > 90 g. Materials and MethodsThis prospective, single-center, single-arm study was conducted in 35 patients with prostate volumes ranging from 90–252 g. Mean patient age was 64.8 years (range, 53–77 y). Magnetic resonance imaging, uroflowmetry, and the International Prostate Symptom Score (IPSS) were used to assess clinical and functional outcomes. ResultsMean prostate size decreased significantly from 135.1 g before PAE to 91.9 g at 3 months of follow-up (P < .0001). Mean IPSS and quality-of-life index improved from 18.3 to 2.7 and 4.8 to 0.9 (P < .0001 for both), respectively. A significant negative correlation was observed between prostate-specific antigen at 24 hours after PAE and IPSS 3 months after PAE (P = .0057). ConclusionsPAE is a safe and effective treatment for lower urinary tract symptoms secondary to benign prostatic hyperplasia in patients with prostate volume > 90 g. Excessively elevated prostate-specific antigen within 24 hours of PAE is associated with lower symptom burden in short-term follow-up.

1:30 PM, Abstract No. 108 - Prostatic arterial embolization, as an alternative to surgery, for patients with benign prostatic hyperplasia refractory to medical therapy: results in 500 cases

1:30 PM, Abstract No. 108 - Prostatic arterial embolization, as an alternative to surgery, for patients with benign prostatic hyperplasia refractory to medical therapy: results in 500 cases

2:02 PM Abstract No. 154 - Early findings from a prospective US trial: prostatic artery embolization (pae) in the treatment of benign prostatic hyperplasia (BPH)

Purpose To present early findings from a prospective US trial: Prostatic Artery Embolization (PAE) in the Treatment of Benign Prostatic Hyperplasia (BPH). The purpose of this trial is to study the safety and efficacy of PAE over 2 years, using spherical embolic material, in the treatment of lower urinary tract symptoms (LUTS). Materials and Methods A prospective trial to perform PAE in 30 patients with moderate or severe grade LUTS has been approved by our Institutional Review Board. Inclusion criteria are: age ≥ 50, AUA score ≥ 8, maximum urinary flow rate 1.6, bladder or prostate carcinoma, or neurogenic bladder. AUA score, Prostate Volume, Peak Urine Flow and Post-void Residual Volume are assessed at baseline and at 6 months. Patients are evaluated at 1,3,12, and 24 months with AUA and sexual function scales (International Index of Erectile Function). Primary endpoints are clinical improvement as measured by AUA score at 12 and 24 months. Seven patients (mean age 70, range 63-80) who signed informed written consent, underwent angiographic. Mean baseline AUA score was 23.8 (range 22-28). Embolization was performed using spherical embolic material (Embozene, Celonova Biosciences San Antonio, TX). Mean prostate volume at baseline was 54.2 cc (range 29-92 cc). Results Embolization was technically successful in 6/7 patients (86%) and bilateral in 6/6 (100%) patients. One technically unsuccessful embolization was secondary to atherosclerotic occlusion of the prostatic arteries. Six patients were discharged on the same day as the procedure and one patient was observed overnight. No patients required bladder catheterization for the procedure or post-procedure. No patients experienced procedural pain, however all patients did experience transient increase in urinary frequency for 24 hours. Clinical improvement at 1 month was noted in all (100%) patients with a mean AUA score of 13 (range 7-17). No minor or major complications were encountered. Conclusion Early results of PAE are encouraging with symptomatic improvement and lack of complication. Continued enrollment with long term follow-up is ongoing.