Prostatic Artery Embolization Research Articles

Prostatic Artery Embolization in Elderly Comorbid Patients with Benign Prostatic Hyperplasia: Safety, Efficacy, and Predictive Factors of Clinical Failure.

Background: This study aims to evaluate the safety and efficacy of prostatic artery embolization (PAE) in elderly, multimorbid patients with benign prostatic hyperplasia (BPH). Additionally, it seeks to identify technical and clinical factors that predict clinical failure at the mid-term follow-up. Methods: We analyzed the clinical records of 175 consecutive patients who underwent PAE. Technical success was defined as achieving embolization on at least one side. Safety was assessed using the Clavien-Dindo classification. The pre-procedural international prostate symptom score (IPSS), quality of life (QoL) score, prostate volume (PV), prostate-specific antigen (PSA), maximum urinary flow rate (Qmax), and post-void residual urine (PVR) were compared with values assessed at the follow-up evaluation. Clinical failure was defined as no improvement or worsening of lower urinary tract symptoms (LUTS) based on the IPSS at the follow-up evaluation. Univariate and multivariate regression models were applied to identify predictors of clinical failure. Results: 158 patients met the inclusion criteria. The median age was 74 years (68, 79), with a median ASA score of 2 (2, 3) and a Charlson comorbidity index (CCI) of 5 (4, 7). Follow-up assessments were carried out at a median of 12 months (0, 1). IPSS decreased by -5 points (-8, 0), QoL by -1 point (-1, 0), PV by -19 cc (-26, -8), PVR by -45 cc (-25 to -80), and PSA by -1.1 ng/mL (-2.5, -0.2) (p < 0.01); while Qmax improved by 4 mL/s (2, 6) (p < 0.01). A total of 44 patients (30.3%) experienced clinical failure, which was significantly correlated with unilateral embolization (p < 0.01). Multivariate regression analysis indicated that higher CCI, elevated PVR, and the use of larger microspheres were associated with poorer clinical outcomes, with odds ratios of 2.17 (95% CI: 1.4-3.38), 1.02 (95% CI: 1.01-1.03), and 26.83 (95% CI: 4.81-149.8), respectively (p < 0.01). Conclusions: PAE is a safe and effective treatment for elderly multimorbid patients with BPH. Comprehensive pre-procedural clinical assessment, incorporating the CCI and PVR, is essential to optimize treatment outcomes.

Early experience of prostate artery embolization: a retrospective single-centre study.

The aim of this study was to evaluate the early experiences of prostate artery embolization (PAE) in patients with benign prostatic hyperplasia (BPH). This retrospective study included all patients treated for BPH who were referred to the radiology department for PAE in Västmanland between 2018 and 2021. Data were collected on patient demographics, International Prostate Symptom Score (IPSS), prostate-specific antigen level, and peri- and post-procedure outcomes. Clinical success was defined as a decrease in the IPSS by ≤3 points or catheter freedom. A total of 96 patients (median age 74 years) underwent PAE. Before PAE, 65% of the patients were treated with α-blockers and 83% with 5α-reductase inhibitors. Clinical success was achieved in 60 patients (63%). Among catheterized patients, 33 (53%) achieved catheter freedom. In the non-catheterized group, 27 (79%) experienced clinical success. No significant differences in outcomes were observed based on the presence of a median lobe. PAE appears to be a viable treatment option for BPH and may provide substantial symptom relief and catheter freedom for most patients. These findings suggest that PAE may be an effective alternative to more invasive procedures. Further research is needed to refine the patient selection criteria.

A modified technique for radial artery access: how interventional radiologists can optimise the cardiologists’ technique to suite their procedures

BackgroundThis is a single-centre prospective observational study examining radial access in 62 Prostatic Artery Embolisation (PAE) procedures. Evaluation of left radial artery diameter using high frequency ultrasound before and after administration of sublingual glycerl trinitrate (GTN). Pre-procedure questionnaires calculating symptom severity score compared with post-procedure.ResultsSublingual GTN resulted in a statistically significant increase in radial artery diameter (p < .00001). There was a statistically significant reduction in both average International Prostate Symptom Score (IPSS) and Quality of Life (QoL) from pre-procedure to post-PAE. The radial sheath was successfully inserted in 100% of cases. Crossover rate to femoral access was low (4%). Radial artery access had a low complication rate (2%). Radial artery variant anatomy was reasonably common (7%).ConclusionsSublingual GTN significantly increase radial artery diameter. PAE from radial access is associated with a symptomatic improvement at 2-month follow-up.

Effect of glyceryl trinitrate and clevidipine administration on CT angiogram findings in dogs undergoing prostatic artery embolization for prostatic carcinoma.

The primary aim of this study was to evaluate the effects of vasodilator administration on CT angiography (CTA) prostatic artery diameter and peak opacification in dogs with prostatic carcinoma prior to prostatic artery embolization (PAE). A prospective clinical trial was performed. Ten dogs with naturally occurring prostatic carcinoma and no evidence of cardiovascular disease were enrolled. Each dog underwent multiphase CTA of the prostate before and after IV vasodilator (glyceryl trinitrate [GTN] or clevidipine butyrate [clevidipine]) administration, and cardiovascular parameters were monitored. PAE was performed the following day. Prostatic arterial anatomy was characterized by CTA. Prostatic artery lumen diameter and peak opacification were measured on pre- and post-vasodilator CTA by a blinded radiologist. The percent change of these measurements was calculated and assessed for significance. Glyceryl trinitrate and clevidipine were administered in 5 dogs each with subsequent blood pressure reduction documented in all dogs. No significant difference was detected in prostatic artery diameter or peak opacification between pre- vs. post-vasodilator CTA. Good agreement in prostatic arterial branch number, origin, and course was documented between pre- and post-vasodilator CTA images. Study findings do not support the routine use of vasodilator administration during pre-PAE CTA in dogs, though larger sample sizes and protocol alterations may be needed to detect a clinically relevant utility.

Safety and Clinical Efficacy of Prostatic Artery Embolization in Patients with Indwelling Urinary Catheter for Benign Hyperplasia-A Multicenter Study.

Background/Objectives: This multicentric study aimed to evaluate the efficacy and safety of prostatic artery embolization (PAE) to remove indwelling urinary catheter (IUC) in patients with symptomatic benign prostatic hyperplasia (BPH). Secondary objectives were to identify features associated with post-PAE catheter-free survival (PCFS). Methods: All consecutive patients who underwent PAE for IUC related to BPH with a follow-up of at least 2 years (except for early death) in 6 French University Hospitals were retrospectively included. Clinical efficacy was defined as the removal of the IUC after PAE (through a trial without catheter [TWOC]) and evaluated at regular intervals. Chi-square tests, Wilcoxon tests and multivariable binary logistic regressions were utilized to investigate predictors of TWOC success. Univariable and multivariable Cox regressions were utilized to investigate predictors of PCFS in patients with TWOC success. Results: 140 men with IUC (median age: 82.5 years, interquartile range [IQR] = 73-88.2 years, range: 46-100) who underwent PAE between January 2017 and March 2021 were included. Initial successful catheter removal (TWOC success) following PAE occurred in 113/140 (80.7%) patients, and 3/140 (2.1%) patients encountered major complications. In patients with TWOC success, PCFS at 6 months, 1 year and 2 years were 87.5% (95%CI: 81.4-94.1), 84.4% (95%CI: 77.7-91.7) and 79% (71.3-87.4), respectively. No independent predictive factors for TWOC success and PCFS were identified. Conclusions: PAE should be considered as a safe option with good clinical efficacy in the short and long term for elderly and inoperable patients with IUC due to symptomatic BPH.

Variation in Cone Beam Computed Tomography Utilization and Radiation Exposure Associated with Prostatic Artery Embolization on Two Separate Angiography Systems.

Background: We aimed to compare cone beam computed tomography (CBCT) utilization and radiation exposure during prostatic artery embolization (PAE) procedures on two different angiography systems. Methods: PAEs performed by a single interventionalist between January 2018 and October 2020 on two multivendor angiography systems (AS1 and AS2) at a single center were retrospectively evaluated. Imaging techniques included CBCT acquisition when possible, predominantly from the distal aorta in AS1 and from the bilateral internal iliac arteries in AS2 (Discovery IGS 740, GE HealthCare, Chicago, IL). Baseline demographics, CBCT utilization and radiation doses, and total procedure radiation metrics for each group were collected and compared. Results: One hundred and twenty patients were analyzed in this study, with fifty-three patients (n = 25 in AS1, 28 in AS2) included as embolized bilaterally using CBCT. CBCT was acquired in 31% of the cases in AS1 and in 85% of the cases in AS2. Mean prostate volume was similar in both groups (103.0 mL vs. 130.1 mL, p = 0.23). There was no difference in fluoroscopy time, while the number of DSA series and CBCTs per case did differ in AS1 and AS2 (37.3 min vs. 32.1 min, p = 0.13, 19.8 vs. 8.0, p ≤ 0.001, 1.3 vs. 2.1 p ≤ 0.001). The mean total air kerma, total kerma area product and air kerma per CBCT were higher in AS1 compared to AS2 (2020.4 mGy vs. 490.3 mGy, p ≤ 0.001, 259.3 Gy*cm2 vs. 72.7 Gy*cm2, p ≤ 0.001 and 217.8 mGy vs. 45.8 mGy, p ≤ 0.001 respectively). To prevent confounding from a mean difference in body mass index, the data were adjusted using log outcome means, which corroborated the raw data findings. Conclusions: The mean procedural total kerma area product from AS1 was similar to that reported in other PAE studies, but it was substantially lower in AS2. The angiography system used has a significant impact on the ability to leverage CBCT and on overall patient and thus staff radiation exposure.

Long-term Efficacy of Prostatic Artery Embolization Alone Versus Prostatic Artery Embolization Followed by HoLEP for Large (&gt; 80 cm3) Benign Prostatic Hyperplasia

Long-term Efficacy of Prostatic Artery Embolization Alone Versus Prostatic Artery Embolization Followed by HoLEP for Large (&gt; 80 cm3) Benign Prostatic Hyperplasia

Combination Prostatic Artery Embolization Prior to Water-Jet Ablation (Aquablation) for Benign Prostatic Hypertrophy: A Propensity Score Analysis.

Objectives: To compare post-operative bleeding measures in patients who underwent prostatic artery embolization (PAE) prior to water-jet ablation (aquablation) vs. water-jet ablation alone. Methods: A retrospective review identified 145 patients treated with water-jet ablation for benign prostatic hyperplasia from December 2018 to June 2021. Patients were divided into two groups: water-jet ablation alone (n = 56) vs. pre-operative PAE and water-jet ablation (n = 89). Patient demographics, pertinent laboratory values, operative reports, and hospital courses were reviewed. Results: PAE was technically successful in all patients (n = 89), and all 89 patients underwent successful water-jet ablation within a median time of 2 days. Compared to water-jet ablation alone, pre-operative PAE resulted in a significant reduction in post-operative bleeding as measured via lower rates of continuous bladder irrigation, hemostatic measures, and hematuria. Pre-operative PAE was also associated with lower rates of post-operative urinary retention (odds ratio 17, p = 0.02) and less likely to require reoperation 30 days after the procedure (p = 0.003). There were no major PAE-related adverse events reported in the combination arm. Conclusions: Compared to water-jet ablation alone, pre-operative PAE resulted in fewer bleeding-related complications and urinary retention.

Prostatic Artery Embolization for the Treatment of Benign Prostatic Hyperplasia: A Retrospective Single-Center Study.

Introduction The purpose of this study is to assess the effectiveness and short-term outcomes of prostatic artery embolization (PAE) in Indian patients suffering from benign prostatic hyperplasia (BPH). Methods This retrospective analysis was performed at a single center and included 25 patients with BPH who received PAE from January 2019 to June 2023. The symptoms of patients had been assessed utilizing the International Prostate Symptom Score (IPSS) and the Quality of Life (QoL) questionnaire. The prostate volume and post-void residual (PVR) volume were assessed using transabdominal ultrasonography prior to and following the embolization. The procedure occurred in the interventional radiology suite with the patient under conscious anesthesia, employing polyvinyl alcohol (PVA) particles. Prostate volume, PVR, IPSS, and QoL scores had been assessed at a follow-up three months later. Results Twenty-five males, with an average age of 76.56 years, underwent PAE. Bilateral embolization was conducted in 23 patients, whereas unilateral embolization was executed in two cases. Following a duration of three months, the average maximum improvement was as defined: IPSS, 10.44 ± 2.91; QoL score, 1.80 ± 0.81; prostatic volume decrease, 49.40 ± 24.13 cc (43% ± 13.95); and PVR volume, 70.08 ± 39.85 mL (52% ± 14.14) (p < 0.001 for all) as evaluated by the paired t-test. Conclusion PAE is a secure and efficacious intervention for BPH, yielding favorable short-term outcomes for lower urinary tract symptoms.

Prostate Artery Embolization: Mid- to Long-Term Outcomes in 1,075 Patients

PurposeTo assess the mid- to long-term safety and effectiveness of prostatic artery embolization (PAE) at a single-center cohort of 1,075 patients. Materials and MethodsThis institutional review board–approved retrospective study included patients with moderate-to-severe lower urinary tract symptoms (LUTS) or urinary retention who underwent PAE from January 2014 to July 2023. Patients were assessed at 1, 3, 6, and 12 months after PAE and yearly thereafter. The International Prostate Symptom Score (IPSS), quality of life (QoL) score, International Index of Erectile Function-5 (IIEF-5) score, prostate-specific antigen (PSA), prostate volume (PV), postvoid residual, benign prostatic obstruction (BPO) medication usage, urinary catheter status, and further prostate interventions were assessed. Adverse events were recorded and classified using the Society of Interventional Radiology (SIR) adverse events (AEs) severity classification. ResultsThe mean follow-up was 458.4 days (SD ± 559.5). The mean age was 70.4 years (SD ± 9.0), the median (interquartile range) PV was 107 g (76–150 g), and the median preprocedural IPSS, QoL, and IIEF-5 scores and PSA level were 23 (18–28), 5 (4–6), 17 (10–21), and 4.7 ng/mL (2.6–8), respectively. In the LUTS subgroup, at 1–3, 6–12, and 48–60 months, the median IPSS values were 7 (4–12, P < .001), 6 (3–11, P < .001), and 9 (4–15, P < .001), respectively. The QoL scores at the same time points were 2 (1–2, P < .001), 1 (0–2, P < .001), 2 (0–3, P < .001), respectively. Of 126 patients in the retention cohort, 119 (94%) were catheter-free at the 3-month follow-up. Ninety-patients (16% of reintervention eligible patients) required a second prostatic intervention up to 60 months after PAE. After PAE, 65.5% of patients were BPO medication–free at 1 year. Seven patients (0.65%) had severe AEs according to the SIR AE severity classification: (a) transient ischemic attacks, 3; (b) urosepsis, 2 (treated in the inpatient setting with intravenous antibiotics); and (c) prostate sloughing, 2 (needing transurethral resection of the prostate). All AEs resolved without sequelae. ConclusionsIn a large cohort with long-term longitudinal follow-up, PAE shows significant, sustained long-term relief of LUTS, improved QoL, low reintervention rate, and high BPO medication–free rates. Ninety-four percent of catheter-dependent patients at baseline were catheter-free at 3 months.

Preoperative prostatic artery embolization before transurethral resection of the prostate for prostate glands larger than 80 mL: the first randomized controlled trial

BackgroundThis study aimed to evaluate the impact of preoperative prostate artery embolization (PAE) on intraoperative blood loss during transurethral resection of the prostate (TURP) in glands larger than 80 cc. Material and methodsA prospective, surgeon-blinded randomized controlled clinical trial was conducted at a single tertiary center. Patients with a prostate volume of more than 80 cc with indications for TURP were randomized (1:1) to the following groups: preoperative prostatic artery embolization followed by TURP (Group A—intervention arm) and TURP alone (Group B—control arm). The primary outcome studied was blood loss measured as the drop in hemoglobin level postoperatively, and the secondary outcome measured was resection efficiency (resected weight per min) and postoperative complication rate. ResultsOur study included 10 patients each in group, A and B. The median prostate volume was 119 mL and 140 mL and the median preoperative hemoglobin was 13.3 g/dL (interquartile range: 12.5 – 14.3 g/dL) and 14.4 g/dL (interquartile range: 10.1–15.2 g/dL) in groups A and B, respectively. Change in postoperative hemoglobin was significantly greater in Group B than in Group A (−1.4 g/dL versus +0.5 g/dL, P = 0.015). There were no significant differences in the weight of resected prostate chips (52 g versus 73 g, P = 0.089) and resection efficiency (0.7 g/min versus 0.6 g/min, P = 0.853) between groups A and B. Two patients in Group B received one unit of red blood cell transfusion compared to only 1 patient in Group A (P = 1.000). One patient from each group had to be brought back to the operation room for hemostasis. ConclusionOur study demonstrated that preoperative prostate artery embolization reduces intraoperative blood loss in men with large prostates undergoing TURP but did not impact resection efficiency or complication rate.

Analysis of the efficacy of Prostatic Artery Embolization in the treatment of Benign Prostatic Hyperplasia.

To investigate the safety and efficacy of prostatic artery embolization (PAE) in the treatment of lower urinary tract symptoms (LUTS) caused by benign prostatic hyperplasia (BPH), and to investigate predictors of clinical success of PAE. A retrospective analysis was used to collect 107 patients [median age 81.0 (73.0,85.0)] with BPH-related LUTS treated with PAE from September 2014 to February 2022 in a hospital. Repeated measurement ANOVA was used to compare the efficacy evaluation indicators at different times before and after PAE. Univariate and multivariate analyses were used to identify potential predictors of PAE clinical success and establish the optimal joint prediction model. The Receiver Operating Characteristic curves of the quantitative predictors and multivariate model prediction probability values significantly correlated with clinical success were plotted. Of the 107 cases, 103 (96.3%) successfully underwent PAE. The International Prostate Symptom Score (IPSS) decreased from a baseline mean of 24.94 to 10.19 (P < 0.05) 3 months after PAE, and the mean IPSS at 6 months, 12 months and 24 months was 10.12, 11.30 and 11.86, respectively, which were statistically significant compared with baseline (P<0.05). Predictors of clinical success were greater prostate volume (> 65 ml, P = 0.018), adenomatous-dominant benign prostatic hyperplasia (AdBPH)(P = 0.030), indwelling catheterization due to urine retention (P = 0.028), and bilateral embolization (P = 0.018). PAE was able to significantly improve BPH-related LUTS and the outcome indicators remained stable at long-term follow-up. Preoperative urinary retention catheters, AdBPH, larger prostate volume (> 65ml) and bilateral embolization suggest better clinical efficacy.

Prostatic Artery Embolization: A Systematic Review Article

AbstractSince the first case report in 2000, there has been a rapid expansion of prostatic artery embolization (PAE) as a therapy for symptomatic benign prostatic hyperplasia. The published literature and clinical experience show that this procedure is safe and effective. This article discusses the brief history, current issues in technique, and the state of the literature regarding outcomes of PAE. Current and future research topics are also discussed.

Intentionally unilateral prostatic artery embolization: Patient selection, technique and potential benefits.

Prostatic artery embolization (PAE) is a promising but also technically demanding interventional radiologic treatment for symptomatic benign prostatic hyperplasia. Many technical challenges in PAE are associated with the complex anatomy of prostatic arteries (PAs) and with the systematic attempts to catheterize the PAs of both pelvic sides. Long procedure times and high radiation doses are often the result of these attempts and are considered significant disadvantages of PAE. The authors hypothesized that, in selected patients, these disadvantages could be mitigated by intentionally embolizing PAs of only one pelvic side. To describe the authors' approach for intentionally unilateral PAE (IU-PAE) and its potential benefits. This was a single-center retrospective study of patients treated with IU-PAE during a period of 2 years. IU-PAE was applied in patients with opacification of more than half of the contralateral prostatic lobe after angiography of the ipsilateral PA (subgroup A), or with markedly asymmetric prostatic enlargement, with the dominant prostatic lobe occupying at least two thirds of the entire gland (subgroup B). All patients treated with IU-PAE also fulfilled at least one of the following criteria: Severe tortuosity or severe atheromatosis of the pelvic arteries, non-visualization, or visualization of a tiny (< 1 mm) contralateral PA on preprocedural computed tomographic angiography. Intraprocedural contrast-enhanced ultrasonography (iCEUS) was applied to monitor prostatic infarction. IU-PAE patients were compared to a control group treated with bilateral PAE. IU-PAE was performed in a total 13 patients (subgroup A, n = 7; subgroup B, n = 6). Dose-area product, fluoroscopy time and operation time in the IU-PAE group (9767.8 μGy∙m2, 30.3 minutes, 64.0 minutes, respectively) were significantly shorter (45.4%, 35.9%, 45.8% respectively, P < 0.01) compared to the control group. Clinical and imaging outcomes did not differ significantly between the IU-PAE group and the control group. In the 2 clinical failures of IU-PAE (both in subgroup A), the extent of prostatic infarction (demonstrated by iCEUS) was significantly smaller compared to the rest of the IU-PAE group. In selected patients, IU-PAE is associated with comparable outcomes, but with lower radiation exposure and a shorter procedure compared to bilateral PAE. iCEUS could facilitate patient selection for IU-PAE.

Deep Vein Thrombosis Secondary to Benign Prostatic Hyperplasia Managed with Holmium Laser Enucleation of the Prostate after Prostatic Artery Embolization

Deep Vein Thrombosis Secondary to Benign Prostatic Hyperplasia Managed with Holmium Laser Enucleation of the Prostate after Prostatic Artery Embolization

Two-Year Outcomes of Prostatic Artery Embolization for Symptomatic Benign Prostatic Hyperplasia: An International, Multicenter, Prospective Study

PurposeTo describe clinical outcomes among patients with benign prostatic hyperplasia (BPH) 24 months following prostatic artery embolization (PAE).Materials and MethodsThis was an international, multicenter, prospective trial of males with BPH with lower urinary tract symptoms (LUTS) or acute urinary retention (AUR) treated with PAE. The primary outcome was the 12 month change in the International Prostate Symptom Score (IPSS) for patients referred for bothersome LUTS, or urinary catheter independence for patients treated for AUR. Secondary outcome measures included changes in IPSS at 3 and 24 months, changes in quality of life (QoL), changes in the Sexual Health Inventory for Men (SHIM) questionnaire, technical success rate, and adverse events (AEs). Data were summarized using descriptive statistics.ResultsFour hundred seventy-eight consecutive patients underwent PAE (bothersome LUTS: N = 405; AUR: N = 73), mean age was 70 years. For patients treated for bothersome LUTS, mean total IPSS at baseline was 21.8 and decreased to 9.3, 10.6, and 11.2 at 3, 12, and 24 months following PAE, respectively (all p < 0.001); QoL at baseline was 4.7 and decreased to 2.0, 2.1, and 2.3 at 3, 12, and 24 months, respectively (all p < 0.001). The mean SHIM score at baseline and 12 months following PAE was 13.8 and 13.9, respectively. Of the 73 patients treated for AUR, 48 (65.8%) had their indwelling catheter removed within 3 months of PAE and remained catheter free at 24 months. Fifty-five patients (11.5%) experienced ≥ 1 AE and 10 (2.1%) experienced a serious AE.ConclusionPAE is a safe and effective treatment for symptomatic BPH and LUTS.Level of Evidence Level 3Trial registration ClinicalTrials.gov NCT03527589.Graphical

Non-inferiority, randomised, open-label clinical trial on the effectiveness of transurethral microwave thermotherapy compared to prostatic artery embolisation in reducing severe lower urinary tract symptoms in men with benign prostatic hyperplasia: study protocol for the TUMT-PAE-1 trial

BackgroundOne-fourth of men older than 70 years have lower urinary tract symptoms (LUTS) that impair their quality of life. Transurethral resection of the prostate (TURP) is considered the gold standard for surgical treatment of LUTS caused by benign prostatic hyperplasia (BPH) that cannot be managed conservatively or pharmacologically. However, TURP is only an option for patients fit for surgery and can result in complications. Transurethral microwave thermotherapy (TUMT) and prostatic artery embolisation (PAE) are alternative minimally invasive surgical therapies (MISTs) performed in an outpatient setting. Both treatments have shown to reduce LUTS with a similar post-procedure outcome in mean International Prostate Symptom Score (IPSS). It is however still unknown if TUMT and PAE perform equally well as they have never been directly compared in a randomised clinical trial. The objective of this clinical trial is to assess if PAE is non-inferior to TUMT in reducing LUTS secondary to BPH.MethodsThis study is designed as a multicentre, non-inferiority, open-label randomised clinical trial. Patients will be randomised with a 1:1 allocation ratio between treatments. The primary outcome is the IPSS of the two arms after 6 months. The primary outcome will be evaluated using a 95% confidence interval against the predefined non-inferiority margin of + 3 points in IPSS. Secondary objectives include the comparison of patient-reported and functional outcomes at short- and long-term follow-up. We will follow the patients for 5 years to track long-term effect. Assuming a difference in mean IPSS after treatment of 1 point with an SD of 5 and a non-inferiority margin set at the threshold for a clinically non-meaningful difference of + 3 points, the calculated sample size was 100 patients per arm. To compensate for 10% dropout, the study will include 223 patients.DiscussionIn this first randomised clinical trial to compare two MISTs, we expect non-inferiority of PAE to TUMT. The most prominent problems with MIST BPH treatments are the unknown long-term effect and the lack of proper selection of candidates for a specific procedure. With analysis of the secondary outcomes, we aspire to contribute to a better understanding of durability and provide knowledge to guide treatment decisions.Trial registrationClinicalTrials.gov NCT05686525. Registered on January 17, 2023, https://clinicaltrials.gov/study/NCT05686525.

Postoperative urinary incontinence following BPH surgery: insights from a comprehensive national database analysis.

Postoperative urinary incontinence (UI) is a feared complication of BPH surgery. Our study aims to investigate the incidence of UI among patients undergoing different procedures for BPH. A retrospective analysis was conducted using a large national database, containing patient records between 2011 and 2022. The most employed surgical procedures for BPH were considered, including TURP, Transurethral Incision of the Prostate (TUIP), Holmium/Thulium Laser Enucleation of the Prostate (HoLEP/ThuLEP), Open Simple Prostatectomy (OSP), minimally invasive simple prostatectomy (Lap/Rob SP), Photoselective Vaporization of the Prostate (PVP), Prostatic Urethral Lift (PUL), Robotic Waterjet Treatment (RWT - Aquablation®), Water Vapor Thermal Therapy (WVTT - Rezum®) and Prostatic Artery Embolization (PAE). Rates of any type of UI, including stress UI (SUI), urge UI (UUI) and mixed UI (MUI) were assessed. Multivariate regression analysis was used to identify predictors of "persistent" postoperative UI, defined as the presence of an active UI diagnosis at 12 months post-surgery. Among 274,808 patients who underwent BPH surgery, 11,017 (4.01%) experienced persistent UI. UUI rates varied between 0.62% (PAE) and 2.71% (PVP), SUI ranged from 0.04% (PAE) and 2.75% (Lap/Rob SP), while MUI between 0.11% (PAE) and 1.17% (HoLEP/ThuLEP). On multivariable analysis, HoLEP/ThuLEP (OR 1.612; 95% CI: 1.508-1.721; P<0.001), PVP (OR 1.164; 95% CI:1.122-1.208; P<0.001), Open SP (OR 1.424; 95% CI:1.241- 1.624; P<0.001), and Lap/Rob SP (OR 1.667; 95% CI:1.119-2.384; P<0.01) showed significant higher likelihood of UI compared to TURP. PUL (OR 0.604; 95% CI:0.566-0.644; P<0.001), WVTT (OR 0.661; 95% CI:0.579-0.752; P<0.001), RWT (OR 0.434; 95% CI:0.216-0.767; P<0.01), and PAE (OR 0.178; 95% CI:0.111-0.269; P<0.001) were associated with lower likelihood of UI. UI remains a concerning complication following BPH surgery, but it is an uncommon event affecting <5% of patients. Some differences in UI rates and risk might exist among various BPH procedures. These findings underscore the need for thorough patient selection and counseling.

Retrospective observation of the early efficacy and safety of temperature-sensitive liquid embolic agent combined with polyvinyl alcohol microspheres for prostatic artery embolization in the treatment of lower urinary tract symptoms caused by benign prostatic hyperplasia.

In recent years, prostatic artery embolization (PAE) has gradually become a hot topic in the treatment of symptomatic benign prostatic hyperplasia (BPH). However, there is an ongoing debate regarding the best embolization material for PAE. This study aimed to compare the safety and efficacy of the temperature-sensitive liquid embolic agent (TempSLE) combined with polyvinyl alcohol (PVA) microspheres and simple PVA microspheres for PAE in treating lower urinary tract symptoms (LUTS) caused by BPH. The clinical data of 39 patients with LUTS caused by BPH were included in this study, including 21 cases of PVA microspheres group and 18 cases of PVA microspheres + TempSLE group. The changes in various subjective and objective indexes were compared between the two groups before PAE, 1 and 3 months after operation. Three months after operation, the improvement in prostate volume (PV), post-void residual volume (PVR), peak urinary flow rate (Qmax), international prostate symptom score (IPSS), quality of life (QoL) and total prostate-specific antigen (T-PSA) in both groups were significantly improved compared with those before operation (P<0.05). And the above clinical improvement indicators at the 3-month mark demonstrated a statistically significant difference between the two groups (P<0.05). Compared with the PVA microspheres group, the prostate necrosis rate of the PVA microspheres + TempSLE was higher at 1 and 3 months after operation (P<0.05). Moreover, the PVA microspheres + TempSLE group had no significant complications, with the exception of a single case of transient gross hematuria during the perioperative period. The combination of PVA microspheres and TempSLE for PAE appears to be safe and effective in the treatment of symptomatic BPH patients, with a higher degree of damage to hyperplastic prostate tissue compared to simple PVA microspheres embolization.

Evaluation of Vessel Tracking Software for Prostatic Artery Embolization.

To evaluate Vessel Tracking software for determining the prostatic arteries feeding the prostate gland during prostatic artery embolization (PAE) using Conebeam-CT (CBCT). EmboGuide is a software developed to assist interventional radiologists in performing embolization of hypervascular tumors in the liver. In this study, a single-center retrospective image collection of 120 intraprocedural CBCT of 60 patients with benign prostatic hyperplasia treated using PAE between May 2017 and January 2019 was evaluated. All patients received 1 intraprocedural CBCT per side for evaluation of vessel anatomy. The "reference standard" of the vascular anatomy was defined by segmentation of the prostatic gland and marking of the prostatic artery in conjunction with pre-embolization DSA series. The datasets were then anonymized. Three interventional radiologists with experience in PAE from different centers reviewed the images and used the automatic feeder detection to determine the prostatic artery. Finally, two clinical experts compared the feeding vessels indicated in the "reference standard" and those identified by the readers. Objectives of the study were to evaluate the clinical performance of the software based on sensitivity and the agreement between interventional radiologists. Sensitivity was estimated as 0.968 with a 90% confidence interval. Overall agreement was estimated as 0.801 with a 90% confidence interval. On both objectives (Sensitivity and Agreement), specifications were met. The results of this study suggest that EmboGuide can be used to determine the prostate arteries in PAE. The findings could be used to expand the intended use of EmboGuide to include PAE.