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Prostatic arterial embolization for the treatment of lower urinary tract symptoms due to large (>80 mL) benign prostatic hyperplasia: results of midterm follow-up from Chinese population.

Wang MQ, Guo LP, Zhang GD, Yuan K, Li K, Duan F, Yan JY, Wang Y, Kang HY, Wang ZJ - BMC Urol (2015)

Bottom Line: PAE was technically successful in 109 of 117 patients (93.2%).The mean IPSS (pre-PAE vs post-PAE 26.0 vs 9.0; P < .0.01), the mean QoL (5.0 vs 3.0; P < 0.01), the mean Qmax (8.5 vs 14.5; P < 0.01), the mean PVR (125.0 vs 40.0; P < 0.01), and PV (118.0 vs 69.0, with a mean reduction of 41.5%; P < 0.01 ) at 24-month after PAE were significantly different with respect to baseline.PAE is a safe and effective treatment method for patients with LUTS due to large volume BPH.

View Article: PubMed Central - PubMed

Affiliation: Department of Interventional Radiology, Chinese PLA General Hospital Beijing, 100853, Beijing, People's Republic of China. wangmq@vip.sina.com.

ABSTRACT

Background: Currently, large prostate size (>80 mL) of benign prostatic hyperplasia (BPH) still pose technical challenges for surgical treatment. This prospective study was designed to explore the safety and efficacy of prostatic arterial embolization (PAE) as an alternative treatment for patients with lower urinary tract symptoms (LUTS) due to largeBPH.

Methods: A total of 117 patients with prostates >80 mL were included in the study; all were failure of medical treatment and unsuited for surgery. PAE was performed using combination of 50-μm and 100-μm particles in size, under local anaesthesia by a unilateral femoral approach. Clinical follow-up was performed using the international prostate symptoms score (IPSS), quality of life (QoL), peak urinary flow (Qmax), post-void residual volume (PVR), international index of erectile function short form (IIEF-5), prostatic specific antigen (PSA) and prostatic volume (PV) measured by magnetic resonance (MR) imaging, at 1, 3, 6 and every 6 months thereafter.

Results: The prostatic artery origins in this study population were different from previously published results. PAE was technically successful in 109 of 117 patients (93.2%). Follow-up data were available for the 105 patients with a mean follow-up of 24 months. The clinical improvements in IPSS, QoL, Qmax, PVR, and PV at 1, 3, 6, 12, and 24 months was 94.3%, 94.3%, 93.3%, 92.6%, and 91.7%, respectively. The mean IPSS (pre-PAE vs post-PAE 26.0 vs 9.0; P < .0.01), the mean QoL (5.0 vs 3.0; P < 0.01), the mean Qmax (8.5 vs 14.5; P < 0.01), the mean PVR (125.0 vs 40.0; P < 0.01), and PV (118.0 vs 69.0, with a mean reduction of 41.5%; P < 0.01 ) at 24-month after PAE were significantly different with respect to baseline. The mean IIEF-5 was not statistically different from baseline. No major complications were noted.

Conclusions: PAE is a safe and effective treatment method for patients with LUTS due to large volume BPH. PAE may play an important role in patients in whom medical therapy has failed, who are not candidates for open surgery or TURP or refuse any surgical treatment.

No MeSH data available.


Related in: MedlinePlus

Prostatic artery arise from the internal pudendal artery. Images from a patient with severe lower urinary tract symptoms due to benign prostatic hyperplasia (117 mL) underwent PAE. a. Digital subtraction angiography (DSA) of the anterior division of the left internal iliac artery with ipsilateral oblique view demonstrates the left prostatic artery (straight arrow) and the left internal pudendal artery (arrowhead). The asterisk indicates the contrast staining in the left prostate lobe. b. Cone-beam CT image with coronal view after selective catheterization of the anterior division of the left internal iliac artery demonstrates the left prostatic artery (straight arrow) and the left internal pudendal artery (arrowhead). The curved arrow indicates the inferior vesical artery, which is difficult to identifying on the DSA. The asterisk indicates the contrast staining in the left prostate lobe.
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Fig3: Prostatic artery arise from the internal pudendal artery. Images from a patient with severe lower urinary tract symptoms due to benign prostatic hyperplasia (117 mL) underwent PAE. a. Digital subtraction angiography (DSA) of the anterior division of the left internal iliac artery with ipsilateral oblique view demonstrates the left prostatic artery (straight arrow) and the left internal pudendal artery (arrowhead). The asterisk indicates the contrast staining in the left prostate lobe. b. Cone-beam CT image with coronal view after selective catheterization of the anterior division of the left internal iliac artery demonstrates the left prostatic artery (straight arrow) and the left internal pudendal artery (arrowhead). The curved arrow indicates the inferior vesical artery, which is difficult to identifying on the DSA. The asterisk indicates the contrast staining in the left prostate lobe.

Mentions: Based on the analysis of selective DSA, rotational angiography, and CB-CT of the internal iliac arteries, it was possible to identify the number of independent PAs and their origin in 109 patients with 218 pelvic sides. There was one PA in 95.0% of the pelvic sides (207/218) and two independent PAs in 5.1% (11/218). The most frequent PA origin was the gluteal-pudendal trunk (39.5%; 86/218; Figure 1). Other common origins were the superior vesical artery (31.7%; 69/219; Figure 2), the middle third of internal pudendal artery (27.5%; 60/218; Figure 3). Three PAs (1.4%) arise from the middle rectal artery (Table 2).Figure 1


Prostatic arterial embolization for the treatment of lower urinary tract symptoms due to large (>80 mL) benign prostatic hyperplasia: results of midterm follow-up from Chinese population.

Wang MQ, Guo LP, Zhang GD, Yuan K, Li K, Duan F, Yan JY, Wang Y, Kang HY, Wang ZJ - BMC Urol (2015)

Prostatic artery arise from the internal pudendal artery. Images from a patient with severe lower urinary tract symptoms due to benign prostatic hyperplasia (117 mL) underwent PAE. a. Digital subtraction angiography (DSA) of the anterior division of the left internal iliac artery with ipsilateral oblique view demonstrates the left prostatic artery (straight arrow) and the left internal pudendal artery (arrowhead). The asterisk indicates the contrast staining in the left prostate lobe. b. Cone-beam CT image with coronal view after selective catheterization of the anterior division of the left internal iliac artery demonstrates the left prostatic artery (straight arrow) and the left internal pudendal artery (arrowhead). The curved arrow indicates the inferior vesical artery, which is difficult to identifying on the DSA. The asterisk indicates the contrast staining in the left prostate lobe.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4403829&req=5

Fig3: Prostatic artery arise from the internal pudendal artery. Images from a patient with severe lower urinary tract symptoms due to benign prostatic hyperplasia (117 mL) underwent PAE. a. Digital subtraction angiography (DSA) of the anterior division of the left internal iliac artery with ipsilateral oblique view demonstrates the left prostatic artery (straight arrow) and the left internal pudendal artery (arrowhead). The asterisk indicates the contrast staining in the left prostate lobe. b. Cone-beam CT image with coronal view after selective catheterization of the anterior division of the left internal iliac artery demonstrates the left prostatic artery (straight arrow) and the left internal pudendal artery (arrowhead). The curved arrow indicates the inferior vesical artery, which is difficult to identifying on the DSA. The asterisk indicates the contrast staining in the left prostate lobe.
Mentions: Based on the analysis of selective DSA, rotational angiography, and CB-CT of the internal iliac arteries, it was possible to identify the number of independent PAs and their origin in 109 patients with 218 pelvic sides. There was one PA in 95.0% of the pelvic sides (207/218) and two independent PAs in 5.1% (11/218). The most frequent PA origin was the gluteal-pudendal trunk (39.5%; 86/218; Figure 1). Other common origins were the superior vesical artery (31.7%; 69/219; Figure 2), the middle third of internal pudendal artery (27.5%; 60/218; Figure 3). Three PAs (1.4%) arise from the middle rectal artery (Table 2).Figure 1

Bottom Line: PAE was technically successful in 109 of 117 patients (93.2%).The mean IPSS (pre-PAE vs post-PAE 26.0 vs 9.0; P < .0.01), the mean QoL (5.0 vs 3.0; P < 0.01), the mean Qmax (8.5 vs 14.5; P < 0.01), the mean PVR (125.0 vs 40.0; P < 0.01), and PV (118.0 vs 69.0, with a mean reduction of 41.5%; P < 0.01 ) at 24-month after PAE were significantly different with respect to baseline.PAE is a safe and effective treatment method for patients with LUTS due to large volume BPH.

View Article: PubMed Central - PubMed

Affiliation: Department of Interventional Radiology, Chinese PLA General Hospital Beijing, 100853, Beijing, People's Republic of China. wangmq@vip.sina.com.

ABSTRACT

Background: Currently, large prostate size (>80 mL) of benign prostatic hyperplasia (BPH) still pose technical challenges for surgical treatment. This prospective study was designed to explore the safety and efficacy of prostatic arterial embolization (PAE) as an alternative treatment for patients with lower urinary tract symptoms (LUTS) due to largeBPH.

Methods: A total of 117 patients with prostates >80 mL were included in the study; all were failure of medical treatment and unsuited for surgery. PAE was performed using combination of 50-μm and 100-μm particles in size, under local anaesthesia by a unilateral femoral approach. Clinical follow-up was performed using the international prostate symptoms score (IPSS), quality of life (QoL), peak urinary flow (Qmax), post-void residual volume (PVR), international index of erectile function short form (IIEF-5), prostatic specific antigen (PSA) and prostatic volume (PV) measured by magnetic resonance (MR) imaging, at 1, 3, 6 and every 6 months thereafter.

Results: The prostatic artery origins in this study population were different from previously published results. PAE was technically successful in 109 of 117 patients (93.2%). Follow-up data were available for the 105 patients with a mean follow-up of 24 months. The clinical improvements in IPSS, QoL, Qmax, PVR, and PV at 1, 3, 6, 12, and 24 months was 94.3%, 94.3%, 93.3%, 92.6%, and 91.7%, respectively. The mean IPSS (pre-PAE vs post-PAE 26.0 vs 9.0; P < .0.01), the mean QoL (5.0 vs 3.0; P < 0.01), the mean Qmax (8.5 vs 14.5; P < 0.01), the mean PVR (125.0 vs 40.0; P < 0.01), and PV (118.0 vs 69.0, with a mean reduction of 41.5%; P < 0.01 ) at 24-month after PAE were significantly different with respect to baseline. The mean IIEF-5 was not statistically different from baseline. No major complications were noted.

Conclusions: PAE is a safe and effective treatment method for patients with LUTS due to large volume BPH. PAE may play an important role in patients in whom medical therapy has failed, who are not candidates for open surgery or TURP or refuse any surgical treatment.

No MeSH data available.


Related in: MedlinePlus