[Prostate artery embolization (PAE) : Technique and results]

Value of magnetic resonance angiography before prostatic artery embolization for intervention planning

Knowledge about anatomical details seems to facilitate the procedure and planning of prostatic artery embolization (PAE) in patients with symptomatic benign prostatic hyperplasia (BPS). The aim of our study was the pre-interventional visualization of the prostatic artery (PA) with MRA and the correlation of iliac elongation and bifurcation angles with technical success of PAE and technical parameters. MRA data of patients with PAE were analysed retrospectively regarding PA visibility, PA type, vessel elongation, and defined angles were correlated with intervention time, fluoroscopy time, dose area product (DAP), cumulative air kerma (CAK), contrast media (CM) dose and technical success of embolization. T-test, ANOVA, Pearson correlation, and Kruskal-Wallis test was applied for statistical analysis. Between April 2018 and March 2021, a total of 78 patients were included. MRA identified the PA origin in 126 of 147 cases (accuracy 86%). Vessel elongation affected time for catheterization of right PA (p = 0.02), fluoroscopy time (p = 0.05), and CM dose (p = 0.02) significantly. Moderate correlation was observed for iliac bifurcation angles with DAP (r = 0.30 left; r = 0.34 right; p = 0.01) and CAK (r = 0.32 left; r = 0.36 right; p = 0.01) on both sides. Comparing the first half and second half of patients, median intervention time (125 vs. 105 min.) and number of iliac CBCT could be reduced (p < 0.001). We conclude that MRA could depict exact pelvic artery configuration, identify PA origin, and might obviate iliac CBCT. Vessel elongation of pelvic arteries increased intervention time and contrast media dose while the PA origin had no significant influence on intervention time and/or technical success.

3-T MRI and clinical validation of ultrasound-guided transperineal laser ablation of benign prostatic hyperplasia

Background

Transperineal laser ablation (TPLA) of the prostate is a novel, mini-invasive option for men with lower urinary tract symptoms (LUTS) due to benign prostate hyperplasia (BPH). Our aim was to assess the impact of ultrasound-guided TPLA regarding urodynamic improvement and sexual function, monitoring clinical data, postprocedural complications and imaging findings at 3-T multiparametric magnetic resonance imaging.

Methods

Forty-four patients aged ≥ 50 affected with moderate to severe LUTS (International Prostate Symptoms score ≥ 12) due to benign prostatic obstruction and refractoriness, intolerance or poor compliance to medical therapies underwent US-guided TPLA between May 2018 and February 2020. Clinical measurements included PSA, uroflowmetry, sexual function assessment (using the International Index of Erectile Function and Male Sexual Health Questionnaire-Ejaculatory Dysfunction short form) and quality of life questionnaire. Adverse events were evaluated using the Clavien-Dindo scale. Volume changes were measured by MRI and automatic segmentation software during 1-year follow-up. Registration: NCT04044573 – May 5th, 2018, https://www.clinicaltrials.gov

Results

MRI assessed the changes over time with a 53% mean reduction of adenoma volume and 71% of the ablated area, associated with clinical and functional improvement and resolution of LUTS in all cases. Five of 44 patients (11.3%) had urinary blockage due to clots and required re-catheterisation for 2 weeks. The overall adverse event rate was 7%.

Conclusion

US-guided TPLA performed as a safe, manageable and effective treatment for LUTS. It could be considered an alternative effective mini-invasive procedure to standard treatments for BPH in the outpatient setting.

Prostatic artery embolization treatment for patients with benign prostatic hyperplasia who are permanent urinary catheter users ineligible for de-obstructive surgery

INTRODUCTION

Benign prostatic hyperplasia is considered the most frequent cause of lower urinary tract symptoms. Urinary catheterization is the emergency treatment for patients with urinary retention and surgery is indicated in patients refractory to medical treatment. There is a group of people with important comorbidities that make them ineligible for surgery. Prostatic arterial embolization (PAE) could be presented as a safe and effective alternative to achieve bladder emptying and spontaneous urination, thus avoiding permanent urinary catheterization in patients with significant comorbidities that represent a contraindication for surgery. In this retrospective study, we evaluated the efficacy of PAE in patients with permanent urinary catheterization who are ineligible for surgical treatment.

MATERIAL AND METHODS

Retrospective study of 26 patients with permanent urinary catheter who underwent prostatic embolization. Demographic and clinical data (age, use of anticoagulation, prostate volume, length of hospital stay, unilateral or bilateral embolization), Charlson comorbidity index evaluation and Clavien-Dindo classification for procedural complications were reviewed. Successful removal of permanent urinary catheter was analyzed at one month after the procedure.

RESULTS

A total of 26 patients were included in the review. The median age was 85 years with a median prostate volume of 90 mL. A Charlson comorbidity score above 7 was obtained in 88.5% of the subjects. Only one patient had one Clavien-Dindo III complication. Of the 26 subjects, 17 (65.4%) had spontaneous micturition and a postvoid residual lower than 100 mL at one month post procedure. Overall, catheter removal was achieved in 19 out of 26 subjects (73.1%).

CONCLUSION

PAE is a safe and effective treatment for patients with permanent urinary catheterization who are ineligible for surgical treatment.

Prostatic artery embolization treatment for patients with benign prostatic hyperplasia who are permanent urinary catheter users ineligible for de-obstructive surgery

INTRODUCTION

Benign prostatic hyperplasia is considered the most frequent cause of lower urinary tract symptoms. Urinary catheterization is the emergency treatment for patients with urinary retention and surgery is indicated in patients refractory to medical treatment. There is a group of people with important comorbidities that make them ineligible for surgery. Prostatic arterial embolization (PAE) could be presented as a safe and effective alternative to achieve bladder emptying and spontaneous urination, thus avoiding permanent urinary catheterization in patients with significant comorbidities that represent a contraindication for surgery. In this retrospective study, we evaluated the efficacy of PAE in patients with permanent urinary catheterization who are ineligible for surgical treatment.

MATERIAL AND METHODS

Retrospective study of 26 patients with permanent urinary catheter who underwent prostatic embolization. Demographic and clinical data (age, use of anticoagulation, prostate volume, length of hospital stay, unilateral or bilateral embolization), Charlson comorbidity index evaluation and Clavien-Dindo classification for procedural complications were reviewed. Successful removal of permanent urinary catheter was analyzed at one month after the procedure.

RESULTS

A total of 26 patients were included in the review. The median age was 85 years with a median prostate volume of 90mL. A Charlson comorbidity score above 7 was obtained in 88.5% of the subjects. Only one patient had one Clavien-Dindo III complication. Of the 26 subjects, 17 (65.4%) had spontaneous micturition and a postvoid residual lower than 100mL at one month post procedure. Overall, catheter removal was achieved in 19 out of 26 subjects (73.1%).

CONCLUSION

PAE is a safe and effective treatment for patients with permanent urinary catheterization who are ineligible for surgical treatment.

Interventional therapy in benign conditions of the prostate

Interventional therapies (IT) are increasingly popular treatment options for benign prostatic hyperplasia (BPH). IT aim to reduce morbidity and side effects related to invasive surgical procedures. To date, IT are considered experimental, though they are evolving rapidly and starting to challenge established surgical strategies. With gradually increasing evidence for the benefits of IT in BPH, several techniques are moving out of the realm of research and into everyday clinical practice. As such, IT provides encouraging mid-term functional outcomes with improved health-related quality of life (QoL), particularly in terms of better preservation of ejaculation. The distinct role IT could play as a bridge between exhausted drug-based treatment options and surgery is yet to be defined. Further studies are required before IT can be recommended as alternatives to invasive therapies. Systematic trials are needed to identify subgroups of patients who can benefit particularly from IT in comparison to other treatments, to identify features of the prostate particularly suited to a specific IT, and to analyze the durability of success for each technique.

Radiation Dose in Prostatic Artery Embolization Using Cone-Beam CT and 3D Roadmap Software

PURPOSE

To evaluate the radiation dose in patients undergoing prostatic artery embolization (PAE) using cone-beam CT and 3-dimensional (3D) guidance software.

MATERIALS AND METHODS

In this single-center retrospective study, 100 patients with benign prostatic hyperplasia (mean prostate volume, 83.6 mL ± 44.2; 69.4 ± 9.6 years of age; body mass index, 26.5 ± 4.2) were treated using PAE between October 2016 and April 2018. Informed consent was obtained from all participants included in the study. All patients received at least 1 intraprocedural cone-beam CT per side for evaluation of the vessel anatomy and software rendering of 3D guidance for catheter guidance. Digital subtraction angiography (DSA) was performed in the distal branches only. The total dose area product (DAP), along with the DAP attributed to fluoroscopy, DSA, and cone-beam CT, were assessed.

RESULTS

Bilateral embolization was achieved in 83 patients (83%). The average total DAP was 134.4 Gy ⋅ cm² ± 69.5 (range, 44.7-410.9 Gy ⋅ cm²). Fluoroscopy, DSA, and cone-beam CT accounted for 35.5 Gy ⋅ cm² ± 21.3 (range, 8.6-148.6 Gy ⋅ cm²) or 26.4% (percentage of total DAP), 58.2 Gy ⋅ cm² ± 48.3 (range, 10.3-309.3 Gy ⋅ cm²) or 43.3%, and 40.7 Gy ⋅ cm² ± 14.5 (range, 15.9-86.3 Gy ⋅ cm²) or 30.3%, respectively. Average procedure time was 89.4 ± 27.0 minutes, and the average fluoroscopy time was 30.9 ± 12.2 minutes.

CONCLUSIONS

Intraprocedural cone-beam CT in combination with 3D guidance software allows for identification and catheterization of the prostatic artery in PAE. Furthermore, the results of this trial indicate that this study protocol may lead to a low overall radiation dose.