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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

Images from a patient with lower urinary tract symptoms due to large benign prostatic hyperplasia (107 mL) underwent bilateral PAE. a. Angiography after selective catheterization of the riht prostatic artery (straight arrow) demonstrates contrast staining in the right prostate lobe (asterisk). b. Cone-beam CT image with coronal view after super-selective catheterization of the right prostatic artery demonstrates the the anterior-lateral prostatic branch (arrowhead), supplying to the central gland; the posterior-lateral prostatic branch (straight arrow), supplying to the peripheral and caudal gland. The asterisk indicates the contrast staining in the right prostate lobe and the curved arrow indicates the right internal pudendal artery. c. Angiography after super-selective catheterization of the left prostatic artery (straight arrow) demonstrates the corkscrew pattern of intra-prostate arteriola and contrast medium staining in the left prostate lobe (asterisk). d. Cone-beam CT image with coronal view after super-selective catheterization of the left prostatic artery (straight arrow) demonstrates contrast medium staining in the left prostate lobe (asterisk). The curved arrow indicates a branch of superior vesical artery, usually presented with high pressure injection of contrast medium through the anastomoses.
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Fig4: Images from a patient with lower urinary tract symptoms due to large benign prostatic hyperplasia (107 mL) underwent bilateral PAE. a. Angiography after selective catheterization of the riht prostatic artery (straight arrow) demonstrates contrast staining in the right prostate lobe (asterisk). b. Cone-beam CT image with coronal view after super-selective catheterization of the right prostatic artery demonstrates the the anterior-lateral prostatic branch (arrowhead), supplying to the central gland; the posterior-lateral prostatic branch (straight arrow), supplying to the peripheral and caudal gland. The asterisk indicates the contrast staining in the right prostate lobe and the curved arrow indicates the right internal pudendal artery. c. Angiography after super-selective catheterization of the left prostatic artery (straight arrow) demonstrates the corkscrew pattern of intra-prostate arteriola and contrast medium staining in the left prostate lobe (asterisk). d. Cone-beam CT image with coronal view after super-selective catheterization of the left prostatic artery (straight arrow) demonstrates contrast medium staining in the left prostate lobe (asterisk). The curved arrow indicates a branch of superior vesical artery, usually presented with high pressure injection of contrast medium through the anastomoses.

Mentions: Follow-up data were available for the 105 patients, who were observed for a mean of 24 months (range 17–36 months). Four patients were lost to follow-up. The proportion of patients who demonstrated clinical success at 1, 3, 6, 12, and 24 months was 94.3% (99 of 105 patients), 94.3% (99/105 patients), 93.3% (98 of 105 patients), 92.6% (87 of 94 patients), and 91.7% (77 of 84 patients), respectively. As shown in Table 3, the LUTS of the patients showed significant improvements. Significant infarcts (mean 60%, range 55 %-90 %) were seen in all patients with clinical success as measured by MRI at 1-month after PAE, exclusively in the prostatic central zone; the infarct areas were reduced progressively in size. At 6-12 months after PAE, the infarcts could not be detected clearly in the majority of patients, resulting from the netrotic tissue absorption (Figures 4 and 5).Table 3


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)

Images from a patient with lower urinary tract symptoms due to large benign prostatic hyperplasia (107 mL) underwent bilateral PAE. a. Angiography after selective catheterization of the riht prostatic artery (straight arrow) demonstrates contrast staining in the right prostate lobe (asterisk). b. Cone-beam CT image with coronal view after super-selective catheterization of the right prostatic artery demonstrates the the anterior-lateral prostatic branch (arrowhead), supplying to the central gland; the posterior-lateral prostatic branch (straight arrow), supplying to the peripheral and caudal gland. The asterisk indicates the contrast staining in the right prostate lobe and the curved arrow indicates the right internal pudendal artery. c. Angiography after super-selective catheterization of the left prostatic artery (straight arrow) demonstrates the corkscrew pattern of intra-prostate arteriola and contrast medium staining in the left prostate lobe (asterisk). d. Cone-beam CT image with coronal view after super-selective catheterization of the left prostatic artery (straight arrow) demonstrates contrast medium staining in the left prostate lobe (asterisk). The curved arrow indicates a branch of superior vesical artery, usually presented with high pressure injection of contrast medium through the anastomoses.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Fig4: Images from a patient with lower urinary tract symptoms due to large benign prostatic hyperplasia (107 mL) underwent bilateral PAE. a. Angiography after selective catheterization of the riht prostatic artery (straight arrow) demonstrates contrast staining in the right prostate lobe (asterisk). b. Cone-beam CT image with coronal view after super-selective catheterization of the right prostatic artery demonstrates the the anterior-lateral prostatic branch (arrowhead), supplying to the central gland; the posterior-lateral prostatic branch (straight arrow), supplying to the peripheral and caudal gland. The asterisk indicates the contrast staining in the right prostate lobe and the curved arrow indicates the right internal pudendal artery. c. Angiography after super-selective catheterization of the left prostatic artery (straight arrow) demonstrates the corkscrew pattern of intra-prostate arteriola and contrast medium staining in the left prostate lobe (asterisk). d. Cone-beam CT image with coronal view after super-selective catheterization of the left prostatic artery (straight arrow) demonstrates contrast medium staining in the left prostate lobe (asterisk). The curved arrow indicates a branch of superior vesical artery, usually presented with high pressure injection of contrast medium through the anastomoses.
Mentions: Follow-up data were available for the 105 patients, who were observed for a mean of 24 months (range 17–36 months). Four patients were lost to follow-up. The proportion of patients who demonstrated clinical success at 1, 3, 6, 12, and 24 months was 94.3% (99 of 105 patients), 94.3% (99/105 patients), 93.3% (98 of 105 patients), 92.6% (87 of 94 patients), and 91.7% (77 of 84 patients), respectively. As shown in Table 3, the LUTS of the patients showed significant improvements. Significant infarcts (mean 60%, range 55 %-90 %) were seen in all patients with clinical success as measured by MRI at 1-month after PAE, exclusively in the prostatic central zone; the infarct areas were reduced progressively in size. At 6-12 months after PAE, the infarcts could not be detected clearly in the majority of patients, resulting from the netrotic tissue absorption (Figures 4 and 5).Table 3

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