Outcomes Of Prostatic Artery Embolization Research Articles

Angiographic Imaging of Prostatic Artery Origin in a Greek Population and Correlation With Technical and Clinical Aspects of Prostatic Artery Embolization.

Background This study aimed, first, to angiographically investigate and analyze prostatic artery (PA) origin in a Greek male population with benign prostatic hyperplasia (BPH) treated with prostatic artery embolization (PAE) and, second, to correlate prostatic arterial anatomy with technical and clinical aspects of PAE. Methodology This was a retrospective study of BPH patients who underwent PAE in a single tertiary center in Greece from June 2019 to July 2022. For the first part of the study, PA was imaged with computed tomography angiography (CTA) before PAE and with digital subtraction angiography (DSA) during PAE in all patients. A widely accepted system for the classification of PA origin was applied. Type I, a common origin of PA and superior vesical artery (SVA) from the anterior division of internal iliac artery (IIA). Type II, PA originating from the anterior division of IIA, separate from, and inferior to SVA. Type III, the origin of PA from the obturator artery. Type IV, the origin of PA from the internal pudendal artery. Type V, rarer origins of PA. For the second part of the study, a subgroup of patients from the first part (treated with the same PAE protocol and free of vascular pathology that could have interfered with the technical success of PAE) was selected. In this subgroup, differences in PA origin were correlated with technical aspects (feasibility of catheterization of PA, fluoroscopy time (FT), dose area product (DAP)) and clinical outcomes of PAE. Results After the exclusion of four patients, 159 patients were included in the first part of the study. From a total of 355 PAs, 110 (31%) were compatible with type I, 58 (16.3%) type II, 45 (12.7%) type III, 110 (31%) type IV, and 32 (9%) type V. PA origin from an accessory internal pudendal artery was the most common among the rare origins of type V. Regarding the second part of the study (a subgroup of 101 patients selected to facilitate comparisons between the different types of PA origin), type I was associated with significantly more incidences of failed or difficult catheterization of the PA compared to all other types combined (27/64 vs. 18/138, p < 0.001). Types III, IV, and V showed a relatively low degree of technical difficulty. Patients with type I PA origin of at least one pelvic side (subgroup (I), n = 48) had significantly longer FT and DAP compared to the rest (subgroup (O), n = 53). Clinical success rates of PAE were slightly lower for the subgroup (I), although the difference was not statistically significant (75.8% vs. 83.8% at 18 months post-PAE, p = 0.137). No major complications were observed. Conclusions This is the first study of PA origin in Greece. It was demonstrated that types I and IV of PA origin were the most common and had the same prevalence. Type I showed significantly higher technical difficulty compared to the others, but had no significant impact on the clinical outcomes of PAE.

Long-Term Outcome of Prostatic Artery Embolization for Patients with Benign Prostatic Hyperplasia: Single-Centre Retrospective Study in 1072 Patients Over a 10-Year Period.

Assess long-term outcomes of prostatic artery embolization (PAE) for patients with benign prostatic hyperplasia (BPH). Single centre retrospective study from 2009-2019 including 1072 patients who received PAE and had available follow-up. Patients were evaluated yearly at 1-10years post PAE using the International Prostate Symptom Score (IPSS) and quality of life (QoL), prostate volume (PV), prostate-specific antigen (PSA), peak urinary flow rate (Qmax) and postvoid residual (PVR) volume. The need for prostatic medication, re-intervention rates, repeat PAE and prostatectomy rates were assessed with Kaplan-Meier survival analysis and compared between different embolic agents using Cox regression analysis. Mean follow-up time was 4.39 ± 2.37years. At last follow-up visit, mean IPSS and QoL improvements were -10.14 ± 8.34 (p < .0001) and -1.87 ± 1.48 (p < .0001) points, mean PV reduction was -6.82 ± 41.11 cm3 (p = 0.7779), mean PSA reduction was -1.12 ± 4.60ng/mL (p = 0.9713), mean Qmax increase was 2.72 ± 6.38mL/s (p = 0.0005), mean PVR reduction was -8.35 ± 135.75mL (p = 0.6786). There were 335 patients (31.3%) needing prostatic medication after PAE. Re-intervention rates were 3.4%at 1year, 21.1%at 5years and 58.1%at 10years. Repeat-PAE rates were 2.3%at 1year, 9.5%at 5years and 23.1%at 10years. Prostatectomy rates were 1.1%at 1year, 11.6%at 5years and 35.0%at 10years. No significant differences were found between polyvinyl alcohol particles, Bead Block, Embospheres and Embozenes. PAE induces durable long-term LUTS relief, with re-intervention rates of 20% in the first 5years and 30%-60% > 5years post-PAE.

Abstract No. 109 Comparison of long-term outcomes following PAE in >100ml vs

Prostatic artery embolization (PAE) is a safe and effective alternative for managing lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH) and can be used readily in larger prostates. This study was undertaken to compare the long-term clinical outcomes of PAE in patients with >100ml vs < 100ml PV.

Clinical Outcomes of Prostatic Artery Embolization in Patients with Benign Prostatic Hyperplasia: A Prospective Clinical Study.

To determine the clinical outcomes of prostatic artery embolization applied to patients with Material and methods: The study includes 30 patients diagnosed with benign prostatic hyperplasia in the urology clinic between 2012 and 2016, for whom anesthesia was contraindicated due to advanced age and comorbidities and who underwent prostatic artery embolization. These patients were evaluated before the procedure and in the 1st, 3rd, 6th, and 12th months after the procedure. The mean prostate volume of the patients was 68 cm3 before the procedure and 45 cm3 12 monthsafter the procedure. A statistically significant decrease was observed (P = .001). The mean prostate-specific antigen value was 4.9 ng/dL before the procedure and 2.8 ng/dL 12 months after the procedure (P = .008). The mean Qmax value was 0 mL/s before the procedure and 12 mL/s 12 months after the procedure (P = .001). The mean international prostatic symptom scores value was 35 before and 16 twelve months after the proce-dure (P = .001). While the international index of erectile function value was 8.25 before the procedure, it was8.46 12 months after the procedure (P = .32). The quality of life index value was measured as 3.02 before theprocedure and 3.09 twelve months after the procedure; a statistically significant difference was determined (P = .027). Prostatic artery embolization, which is a minimally invasive procedure, can be applied as a safe and effective method to patients with benign prostatic hyperplasia who cannot tolerate anesthesia due to advanced age and comorbidities.

Potential of pre-interventional magnetic resonance angiography for optimization of workflow and clinical outcome of prostatic arterial embolization

PurposeImpact of pre-interventional magnetic resonance angiography (MRA) on prostatic artery embolization (PAE) regarding workflow, radiation dose, and clinical outcome. MethodRetrospective evaluation of 259 patients (mean age 68 ± 9, range 41–92) with benign prostatic hypertrophy (BPH) undergoing PAE between January 2017 and December 2020. MRA was performed in 137 cases. In 122 patients, no pre-interventional MRA was performed. Origin of the PA, volumetry of the prostatic gland and ADC values were evaluated. International Prostate Symptom Score (IPSS), Quality of Life (QoL) and International Index of Erectile Function (IIEF) were evaluated before and after PAE. ResultsOrigin of the PA was identified in all cases. Significant differences regarding volume reduction (−20 ± 13 ml with MRA vs −17 ± 9 ml without MRA) and ADC value reduction were found (−78 ± 111 10−6 mm2/s with MRA vs −45 ± 99 10−6 mm2/s without MRA). PAE workflow was modified in 16 patients due to MRA findings. Radiation dose (5518.54 ± 6677.97 µGym2 with MRA vs 23963.50 ± 19792.25 µGym2 without MRA) and fluoroscopy times (19.35 ± 9.01 min. with MRA vs 27.45 ± 12.54 min. without MRA) significantly differed. IPSS reduction improved (−11 ± 8 points with MRA vs −7 ± 9 points without MRA, p < 0.001), while QOL (−2 ± 1 points with MRA and −2 ± 2 points without MRA) and IIEF (+2 ± 10 points with MRA and +1 ± 11 points without MRA) showed no significant differences (p > 0.05). ConclusionsPre-interventional MRA facilitates improved workflow and patient safety of PAE while reducing radiation dose and intervention time.

Symptomatic Improvement of Lower Urinary Tract Symptoms of Benign Prostatic Hyperplasia: A Comparative Systematic Review and Meta-Analysis of 4 Different Minimally Invasive Therapies

PurposeTo review and compare the outcomes of prostatic artery embolization (PAE) with 3 other minimally invasive surgical treatments for benign prostatic hyperplasia, including photoselective vaporization (PVP), prostatic urethral lift (PUL), and water vapor thermal therapy (WV). MethodsA literature review was used to identify 35 publications, which included 2,653 patients (studies, patients): PVP (13, 949), PUL (9, 577), WV (3, 330), and PAE (10, 728). The international prostate symptom score (IPSS) and the international index of erectile function (IIEF-5) and quality of life (QOL) scores were recorded at baseline, 6 months, and 12 months. Meta-analyses, pooling the standardized mean difference between scores recorded before and after treatment, were conducted for each modality and time point to assess the magnitude of a therapy’s effect to yield pooled effect sizes. A negative score indicates IPSS and QOL improvement. A positive score indicates IIEF-5 improvement. ResultsAt 6 and 12 months, the IPSS and QOL were most improved after PVP, followed by that after PAE, PUL, and, lastly, WV (measured only at 12 months). Between 6 and 12 months, the IPSS and QOL improved with PAE and worsened with PVP and PUL. Only PAE demonstrated statistical improvement in the IIEF-5, which improved from 6 to 12 months. ConclusionsPVP and PAE resulted in the largest improvements in the IPSS and QOL. Only PAE resulted in improvement of the IIEF-5.

Abstract No. 567 Prostatic artery embolization in patients with prior prostatitis

Prostatic artery embolization (PAE) is an elective procedure to treat lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH). Studies have shown that a prior diagnosis of prostatitis is associated with an increased likelihood of developing BPH (1). This report examines technical and clinical outcomes for BPH patients with prior prostatitis who undergo PAE. All consecutive elective PAEs conducted at 2 hospitals in a tertiary academic health system from June 2014 to August 2020 were collected (n = 216). Patients were included in this study if they had a history of prostatitis prior to elective PAE. For patients meeting these inclusion criteria, demographic, baseline, procedural, and follow-up data were collected by review of electronic medical records. Of the 216 patients receiving elective PAEs queried, nine had prior prostatitis. The mean age of the patients at the time of the procedure was 68.8 years (SD = 16.2). Five patients had a history of acute bacterial prostatitis, three had chronic prostatitis, and one had radiation prostatitis. For eight patients, the date of their most recent episode of prostatitis was available and was an average of 1.9 years before their procedure (SD = 2.4). Procedures had a mean fluoroscopy time of 33.2 minutes and radiation dose of 600752.9 mGycm2. Technical success, defined as bilateral stasis, was achieved in seven of nine procedures. In the other two patients, unilateral embolization was accomplished in one patient, and bilateral failure occurred in one patient. The failures occurred due to the presence of an accessory vessel in one patient, and a double right-angle origin of the prostatic artery bilaterally in the other patient. Two of nine patients presented with hematuria and underwent PAE in an emergent setting, whereas seven patients presented with BPH and LUTS and underwent the procedure in an outpatient setting. Patients with follow-up were evaluated at an average of 71 days post-operatively (SD = 50.7) and experienced a mean reduction in International Prostate Symptom Score of 10.3 (n = 4, SD = 15.1) and a mean reduction in Quality of Life Score of 1.3 (n = 4, SD = 1.5). Prostatitis can increase risk for development of BPH. This initial study demonstrated the feasibility of PAE in patients with prior prostatitis. Further investigation is warranted to determine the impact of a history of prostatitis on the outcomes of PAE.

Intravesical Prostatic Protrusion Does Not Influence the Efficacy of Prostatic Artery Embolization

PurposeTo compare the outcomes of prostatic artery embolization (PAE) in patients with different intravesical prostatic protrusion (IPP) grades. Materials and MethodsThis retrospective single-center study included 128 patients (aged 50–86 years) who underwent PAE from 2013 to 2017. IPP grades were classified as follows: grade I (<10 mm), grade II (10–19 mm), and grade III (≥20 mm). Nineteen patients (14.8%) had grade I [mean IPP 7.8 mm, prostatic volume (PV) 64.1 cm3], 77 (60.2%) had grade II (mean IPP 14.9 mm, PV 87.0 cm3), and 32 (25%) had grade III (mean IPP 26.2 mm, PV 132.6 cm3), P < .01. The outcomes, including PV, international prostate symptom score (IPSS), and quality of life (QoL), were compared between the IPP grades at the 12-month follow-up. Clinical failure was defined as IPSS >7 or QoL >2. ResultsIPP decreased (I: −8.2%, II: −27.3%, and III: −38.7%, P = .01), and all other endpoints improved (P < .01). Adjusted covariance analysis, considering baseline PV as a confounding factor, showed no correlation between the 12-month outcomes and baseline IPP. Clinical failure was observed in 17/128 patients (13.3%) and was similar in prevalence among the IPP groups (P = .20). Minor complications occurred in 43 patients (33.6%) and major in 3 (2.3%). There were statistical differences in the complications between IPP grades II and III (P < .01). ConclusionsPAE was similarly effective in all the IPP grades at the 12-month follow-up, and there was no difference in the clinical failure between the groups. Complications in IPP grade III were more frequent than those in IPP grade II.

Randomized Comparison of Prostatic Artery Embolization versus Transurethral Resection of the Prostate for Treatment of Benign Prostatic Hyperplasia

PurposeTo compare clinical and functional outcomes of prostatic artery embolization (PAE) with those of transurethral resection of the prostate (TURP) for the treatment of lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH). Materials and MethodsNoninferiority randomized trial was conducted involving men over 60 years of age with LUTS secondary to BPH. From November 2014 to January 2017, 45 patients were randomized to PAE (n = 23) or to TURP (n = 22). PAE was performed with 300- to 500-μm microspheres with the patient under local anesthesia, whereas bipolar TURP was performed with the patients under spinal or general anesthesia. Primary outcomes were changes in peak urinary flow (Qmax) and international prostate symptoms score (IPSS) from baseline to 12 months. Quality of life (QoL), and prostate volume (PV) changes from baseline to 12 month were secondary outcomes. Adverse events were compared using the Clavien classification. ResultsMean Qmax increased from 6.1 mL/s in the PAE group and from 9.6 mL/s in the TURP patients (P = .862 for noninferiority), and mean IPSS reduction was 21.0 points for PAE and 18.2 points for TURP subjects (P = .080) at 12 months. A greater QoL improvement was reported in the PAE group (3.78 points for PAE and 3.09 points for TURP; P = .002). Mean PV reduction was 20.5 cm³ (34.2%) for PAE subjects and 44.7 cm³ (71.2%) for TURP subjects (P < .001). There were fewer adverse events reported in the PAE group than in the TURP group (n = 15 vs n = 47; P < .001). ConclusionsReduction of LUTS in the PAE group was similar to that in the TURP group at 12 months, with fewer complications secondary to PAE. Long-term follow-up is needed to compare the durability of the symptomatic improvement from each procedure.

3:18 PM Abstract No. 64 Efficacy of prostatic artery embolization for treatment of lower urinary tract symptoms from benign prostatic hyperplasia in the setting of non-obstructive localized prostate cancer

The purpose of this study is to assess clinical outcomes of prostatic artery embolization (PAE) in men with localized prostate cancer (PCa) and lower urinary tract symptoms (LUTS) from benign prostatic hyperplasia (BPH). From January 2017 to August 2019, 44 men underwent PAE for LUTS. 10 men (mean age, 70.7; range, 48-85; mean PSA, 13; range, 0.5-37.7; mean Gleason score, 7.3; range, 6-9; 8 undergoing ADT) underwent PAE for LUTS in the setting of non-obstructive PCa. Retrospective review of medical records and imaging studies was performed in order to assess International Prostate Symptom Score (IPSS) (n = 6) and quality of life (QoL) (n = 6) at 12 weeks, cross-sectional prostate volume at 6 weeks (n = 8) and at 12 weeks (n = 6), PSA at 12 weeks (n = 5), and imaging disease progression at 12 weeks (n = 5). PAE was technically successful in all patients. No SIR grade moderate or higher adverse effects were seen. One patient experienced mild adverse effect of bladder spasm. IPSS and QoL at 12 weeks improved by a mean of 11.67 (range, 1-25) and 2.33 (range, 1-24) points, respectively. Mean prostate volume reduction at 6 weeks and 12 weeks was 24.5% (range, 7.2-36.7) and 22.4% (range, -17.9-44), respectively. PSA decreased by average 47% at 12 weeks (range, 1.7-93.3). On 12-week MRI, no lesions increased in PIRADS score, 3 lesions decreased by at least 1 point and no extraprostatic disease progression was seen. All patients completed definitive therapy successfully with prostatectomy (n = 1) or radiation therapy (n = 9). PAE for men with LUTS from BPH and non-obstructive PCa results in clinical improvement without increased side effects of non-target embolization or disease progression. PAE is safe and effective for men with LUTS from BPH in the setting of non-obstructive PCa.

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.

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.

Prostatic Artery Embolization-Anatomic Predictors of Technical Outcomes.

To determine if cone-beam CT and digital subtraction angiography analysis of pelvic arterial anatomy has predictive value for radiation exposure and technical success of prostatic artery embolization (PAE). This prospective, nonrandomized, single-center study included 104 consecutive patients with lower urinary tract symptoms secondary to benign prostatic hyperplasia. Cone-beam CT was performed in 160/208 (76.9%) hemipelves to determine prostatic artery (PA) origin. Classification of pelvic arterial tortuosity was possible in 73/104 (70.2%) patients. Learning curves of 2 interventionalists who performed 86.5% of PAEs were analyzed. Tortuosity of pelvic arteries was classified as mild in 25 (34.2%) patients median age 64 years, moderate in 40 (54.8%) patients median age 69 years, and severe in 8 (11.0%) patients median age 70 years (mild vs moderate, P= .002; mild vs severe, P= .019); median fluoroscopy times were 24, 36, and 46 minutes (P= .008, P= .023); median contrast volumes were 105, 122.5, and 142 mL (P= .029, P= .064); and bilateral PAE rates were 84.0%, 77.5%, and 62.5% (P= .437), respectively. PA origin from superior vesical artery was most frequent (27.5%) and showed higher dose area product (median 402.4 vs 218 Gy ∙ cm2, P= .033) and fluoroscopy time (median 42.5 vs 27 min, P= .01) compared with PA origin from obturator artery, which was least frequent. Interventionalist experience revealed significant impact on procedure times (median 159 vs 130 min, P= .006). Tortuosity of pelvic arteries was more frequent in older patients and predicted worse technical outcomes of PAE. PA origin from obturator artery was associated with lower dose area product and fluoroscopy time, especially compared with PA origin from superior vesical artery. Interventionalist experience showed significant influence on technical outcome.

Comparison of Clinical Outcomes of Prostatic Artery Embolization with 50-μm Plus 100-μm Polyvinyl Alcohol (PVA) Particles versus 100-μm PVA Particles Alone: A Prospective Randomized Trial

PurposeTo evaluate the safety and efficacy of prostatic artery embolization (PAE) using the combination of 50-μm and 100-μm polyvinyl alcohol (PVA) particles versus 100-μm PVA particles alone in the treatment of patients with symptomatic benign prostatic hyperplasia (BPH). Materials and MethodsOver a 5-year period, 120 patients treated with PAE for lower urinary tract symptoms (LUTS) secondary to BPH were randomized to undergo embolization with 50-μm plus 100-μm PVA particles (group A) or 100-μm PVA particles alone (group B). Mean follow-up time was 34 months (range, 12–57 mo). There were no differences between groups regarding baseline data. Primary outcome measurements included change in International Prostate Symptom Score (IPSS) and incidence of adverse events. Secondary outcome measurements included procedure-associated pain, prostate ischemia measured on magnetic resonance (MR) imaging 1 week after PAE, and changes over time in quality of life (QOL) questionnaire, peak urinary flow rate (Qmax), postvoid residual (PVR) volume, prostate volume (PV), prostate-specific antigen (PSA) level, and International Index of Erectile Function (IIEF) were evaluated. Recurrence of LUTS following PAE was defined as relief of LUTS temporally but increased IPSS ≥ 8 or QOL score ≥ 3 or decrease in Qmax to < 7 mL/s. ResultsMean follow-up periods were 35 months ± 22 in group A and 33 months ± 25 in group B (P = .629). No differences between groups regarding procedural details, pain scores, or adverse events were noted (P > .05). At 24 month of follow-up, patients in group A had a greater decrease in mean IPSS (18.7 ± 12.5 vs 14.8 ± 13.5), QOL score (3.7 ± 1.5 vs 2.4 ± 1.8), Qmax (10.5 mL ± 9.5 vs 6.8 mL ± 5.0), PVR (92.0 mL ± 75.0 vs 60.0 mL ± 55.0), and PV (37.0 mL ± 19.5 vs 25.5 mL ± 15.0) compared with patients in group B (P < .05 for all). Mean ratios of prostate ischemic volume at 1 week after PAE were 70% ± 20 in group A and 41% ± 25 in group B (P = .021); mean PSA levels at 24 hour after PAE were 92.5 ng/mL ± 55.0 in group A and 77.5 ng/mL ± 45.0 in group B (P = .031); LUTS recurrence rates were 3.6% in group A and 14.6% in group B (P = .024). The mean IIEF-5 was not significantly different from baseline in either group. ConclusionsPAE with 50-μm plus 100-μm PVA particles resulted in greater improvement in clinical and imaging outcomes and no significant differences in adverse events compared with 100-μm PVA particles alone.

Prostatic artery embolization for benign prostatic obstruction: assessment of safety and efficacy.

Prostatic artery embolization (PAE) has seen a recent increase in interest as a treatment for men with benign prostatic obstruction (BPO). The appeal of this intervention lies in reported reduction in morbidity and its minimally invasive nature. The purpose of this review is to assess the safety and efficacy of PAE as a new treatment in BPO and explore risks surrounding its performance. A review of the literature was performed. Medical databases searched included PubMed, EMBASE, and Cochrane databases, limited to English, peer-reviewed articles. Search terms included prostatic artery embolization, lower urinary tracts symptoms, minimally invasive therapies, interventional radiology prostate, and benign prostatic hyperplasia. Articles were screened by two independent reviewers for content on development, methods, outcomes, and complications of PAE. Suitability of patients to undergo PAE depends on review of patient history, pre-procedure visualisation of appropriate vascular anatomy and clinical parameters. Despite this selection of candidates favourable for procedural success, PAE is not without risk of complications, some of which can significantly affect patient quality of life. Although initial findings show promise regarding safety and efficacy of PAE in improving symptom and quality-of-life scores, further investigation is required to establish durability of effect and the appropriate use of this experimental modality. There is currently limited robust evidence for the beneficial outcomes of PAE. Long-term follow-up studies will add to the evidence base to help further assess the feasibility of this procedure as an alternative to TURP.

Case-Control Study of Intra-arterial Verapamil for Intraprostatic Anastomoses to Extraprostatic Arteries in Prostatic Artery Embolization for Benign Prostatic Hypertrophy

PurposeIt is hypothesized that intra-arterial administration of verapamil is a safe and effective way to reverse the flow in intraprostatic anastomoses to extraprostatic arteries without compromising treatment outcomes in prostatic artery embolization (PAE) for benign prostatic hypertrophy (BPH). Materials and MethodsA prospective study of 62 prostate sides in 31 consecutive patients (median age, 66 y; range, 60–71 y) with symptomatic BPH was undertaken. Median prostate volume was 72.4 mL (range, 48.8–85.8 mL), median International Prostate Symptom Score was 21 (range, 15-23), and median urine peak flow rate was 4 mL/s (range, 2–6 mL/s). The arterial anastomoses were classified as types I–III according to vascular morphology. Treatment safety was assessed in terms of adverse events and complications, and treatment effectiveness was assessed in terms of success rate of angiographic flow reversal. ResultsThe PAE procedure was successfully completed in all 31 patients (100%). Adverse events in both groups were transient and mild and did not necessitate prolonged hospitalization. There was no clinical evidence of any significant nontarget ischemic complication in either group. Intraprostatic anastomosis was diagnosed in 19 of 31 patients (61.3%) and 22 of 62 prostate sides (35.5%). Success rates of verapamil treatment were 88.9% overall (20 of 22) and 100% (19 of 19) in type II and III anastomoses. There was no difference between the treatment group and the control group in clinical, urologic, and imaging outcomes of PAE. ConclusionsIntra-arterial verapamil treatment was probably safe and effective in causing flow reversal in type II and III intraprostatic anastomoses and in preventing ischemic complications in PAE for BPH without compromising PAE outcomes.

Does Polyvinyl Alcohol Particle Size Change the Outcome of Prostatic Arterial Embolization for Benign Prostatic Hyperplasia? Results from a Single-Center Randomized Prospective Study

PurposeTo evaluate whether different polyvinyl alcohol (PVA) particle sizes change the outcome of prostatic arterial embolization (PAE) for benign prostatic hyperplasia (BPH). Materials and MethodsA randomized prospective study was undertaken in 80 patients (mean age, 63.9 y; range, 48–81 y) with symptomatic BPH undergoing PAE between May and December 2011. Forty patients underwent PAE with 100-µm (group A) and 200-µm PVA particles (group B). Visual analog scales were used to measure pain, and rates of adverse events were recorded. PAE outcomes were evaluated based on International Prostate Symptom Score (IPSS) and quality-of-life (QoL) questionnaires, prostate volume (PV), prostate-specific antigen (PSA) levels, and peak flow rate measurements at baseline and 6 months. ResultsNo differences between groups regarding baseline data, procedural details, or adverse events were noted. Mean pain scores were as follows: during embolization, 3.2 ± 2.97 (group A) versus 2.93 ± 3.28 (group B); after embolization, 0.10 ± 0.50 (group A) versus 0 (group B; P = .20); and the week after PAE, 0.85 ± 1.65 (group A) versus 0.87 ± 1.35 (group B; P = .96). Patients in group B had greater decreases in IPSS (3.64 points; P = .052) and QoL (0.57 points; P = .07). Patients in group A had a greater decrease in PV (8.75 cm3; P = .13) and PSA level (2.09 ng/mL; P < .001). ConclusionsNo significant differences were found in pain scores and adverse events between groups. Whereas PSA level and PV showed greater reductions after PAE with 100-µm PVA particles, clinical outcome was better with 200-µm particles.

1:54 PM Abstract No. 153 - Unilateral versus bilateral prostatic arterial embolization in patients with benign prostatic hyperplasia

Purpose To compare baseline data and clinical outcome between patients with Prostate Enlargement/Benign Prostatic Hyperplasia (PE/BPH) who underwent unilateral and bilateral Prostatic Arterial Embolization (PAE) for the relief of Lower Urinary Tract Symptoms (LUTS). Materials and Methods Single center ambispective cohort study in 122 consecutive patients (mean patient age 66.7 years) comparing patients with unilateral versus bilateral PAE (March 2009 - September 2011). Selective PAE with 100 μm and 200 μm nonspherical polyvinyl alcohol (PVA) particles. The outcome of PAE was evaluated by International Prostate Symptom Score (IPSS), Quality of Life (QoL) and International Index of Erectile Function (IIEF) measurements, prostate volume (PV) reduction, PSA, Peak Urinary Flow-rate (Qmax) and Post-void Residual Volume (PVR) measurements. Poor outcome after PAE considered when 1 criteria was met: IPSS ≥ 20 and/or reduction Results Mean follow-up 7.1 months (range 3 - 12 months). Group A - Bilateral PAE - 103 (84.4%) patients; Group B - Unilateral PAE - 19 (15.6%) patients. Patients from Group B were significantly older (mean age 71.3 ± 1.7 years, p=0.002), the remaining baseline parameters did no differ significantly. Mean PV reduction of 18.2 mL (19.2%, p 0.05). PSA, Qmax and PVR improvements after PAE did not differ significantly between groups. Poor clinical outcome: Group B 47.4%; Group A 24.3% (23.1% difference, p=0.04). Conclusion PAE is a challenging technique with up to 15% of patients with unilateral embolization. PAE is safe and effective inducing 45% improvement in the IPSS score and a prostate volume reduction of 18%. Bilateral PAE is associated with better clinical results. Up to 50% of patients with unilateral PAE may have a good clinical outcome.

1997 EMBOLIZATION FOR BENIGN PROSTATIC HYPERPLASIA AND VERY LARGE PROSTATE AS AN ALTERNATIVE TO OPEN SURGERY

INTRODUCTION AND OBJECTIVES: Evaluate outcome of prostatic arterial embolization (PAE) for symptomatic patients with benign prostatic hyperplasia (BPH) and very large prostates, after failure of medical therapy for at least 6 months. METHODS: This prospective nonrandomized study included 72 patients (aged 48 80 years, mean age 67.6 6.7 years) with a diagnosis of BPH, very large prostate and moderate to severe lower urinary tract symptoms (LUTS) after failure of medical treatment for at least 6 months, selected for prostatic arterial embolization (PAE) between March 2009 and April 2012. Sixteen patients were in urinary retention and bladder catheter. The procedure was always performed under local anaesthesia and mostly by single femoral approach. Nonspherical Polyvinyl Alcohol Particles (PVA) were used for embolization. The prostate volume ranged between 100 and 269 cc (mean 129.5 32.3 cc). The International Prostate Symptom Score (IPSS), Quality of Life (QoL), International Index Erectile Function (IIEF), uroflowmetry, (Qmax peak urinary flow and PVR post voiding residual volume), Prostatic Specific Antigen (PSA) and prostate volume, were assessed before PAE, at 1, 3, 6 and every 6 months thereafter. Patients were evaluated up to 36 months (mean 12.3 months). RESULTS: PAE was technically successful in 71 of 72 patients (98.6%). Follow up data was available for 67 patients. Four patients were lost to follow up. From the total 67 controlled patients there were 16 (23.9%) clinical failures, 9 at short term and 7 at medium term. At one month there was clinical improvement in 57/67 patients (85.1%). Cumulative rates of clinical success at short term were at 3 months 85.5%, at 6 months 81.4%, at 12 months 78.5%, and at medium term at 18 months 69.8% at 24 months 69.8 %, at 30 months 69.8 and at 36 months 69.8 %. There was low morbidity, no major complication and no sexual dysfunction in this group of patients. CONCLUSIONS: PAE is a minimally invasive procedure with good short and medium term results, for BPH patients with prostates larger than 100cc and moderate to severe lower urinary tract symptoms after failure of medical therapy, and may be considered an alternative to surgery.

628 Clinical outcome of prostatic arterial embolization for patients with benign prostatic hyperplasia and moderate to severe lower urinary tract symptoms – 365 cases

follow-up is 6 months. Mean Qmax, PVR, IPSS, and QoL significantly improved (p 0.001) within the first month and either improved further or remained unchanged. Sexual function maintained and even improved. There were no case of SUI or retrograde ejaculation postoperative. The patient who received 2nd implants is integrated in the evaluation. Two patients underwent TURP due an unsatisfactory initial outcome. CONCLUSIONS: PUL is a minimal invasive surgical technique to alleviate BPH and voiding symptoms. These results are comparable with published clinical studies. It can be performed under LA and does not cause retrograde ejaculation or SUI. A larger patient group comparing treatment outcomes and follow-up are necessary.

P91 Interet de l'appendicectomie sous laparoscopie chez l'enfant

To evaluate whether different polyvinyl alcohol (PVA) particle sizes change the outcome of prostatic arterial embolization (PAE) for benign prostatic hyperplasia (BPH).A randomized prospective study was undertaken in 80 patients (mean age, 63.9 y; range, 48–81 y) with symptomatic BPH undergoing PAE between May and December 2011. Forty patients underwent PAE with 100-µm (group A) and 200-µm PVA particles (group B). Visual analog scales were used to measure pain, and rates of adverse events were recorded. PAE outcomes were evaluated based on International Prostate Symptom Score (IPSS) and quality-of-life (QoL) questionnaires, prostate volume (PV), prostate-specific antigen (PSA) levels, and peak flow rate measurements at baseline and 6 months.No differences between groups regarding baseline data, procedural details, or adverse events were noted. Mean pain scores were as follows: during embolization, 3.2 ± 2.97 (group A) versus 2.93 ± 3.28 (group B); after embolization, 0.10 ± 0.50 (group A) versus 0 (group B; P = .20); and the week after PAE, 0.85 ± 1.65 (group A) versus 0.87 ± 1.35 (group B; P = .96). Patients in group B had greater decreases in IPSS (3.64 points; P = .052) and QoL (0.57 points; P = .07). Patients in group A had a greater decrease in PV (8.75 cm3; P = .13) and PSA level (2.09 ng/mL; P < .001).No significant differences were found in pain scores and adverse events between groups. Whereas PSA level and PV showed greater reductions after PAE with 100-µm PVA particles, clinical outcome was better with 200-µm particles.