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Creta M, Russo GI, Bhojani N, Drake MJ, Gratzke C, Peyronnet B, Roehrborn C, Tikkinen KAO, Cornu JN, Fusco F. Bladder Outlet Obstruction Relief and Symptom Improvement Following Medical and Surgical Therapies for Lower Urinary Tract Symptoms Suggestive of Benign Prostatic Hyperplasia: A Systematic Review. Eur Urol 2024; 86:315-326. [PMID: 38749852 DOI: 10.1016/j.eururo.2024.04.031] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 04/17/2024] [Accepted: 04/25/2024] [Indexed: 09/25/2024]
Abstract
BACKGROUND AND OBJECTIVE Symptomatic benefit and urodynamic obstruction relief represent relevant outcomes of therapies for lower urinary tract symptoms suggestive of benign prostatic hyperplasia (LUTS/BPH). We summarized evidence from studies concurrently assessing variations in terms of symptoms severity and invasive urodynamic measures of obstruction following medical and surgical therapies for LUTS/BPH. METHODS We performed a systematic review of PubMed, Scopus, and Web of Science in June 2023. KEY FINDINGS AND LIMITATIONS We identified 29 publications: 14 (872 patients) and 15 (851 patients) studies addressing medical and surgical therapies, respectively. The mean percentage total International Prostate Symptom Score (IPSS) improvements ranged from -2.5% to 56.3% and from 35.1% to 82.1% following medical and surgical therapies, respectively. The corresponding mean percentage Bladder Outlet Obstruction Index (BOOI) improvements ranged from 7.8% to 53.5% and from 22.4% to 138.6%, respectively. Holmium laser enucleation of the prostate (HoLEP) provided IPSS improvements in the higher range and the greatest BOOI reduction. CONCLUSIONS AND CLINICAL IMPLICATIONS Globally, based on available evidence, more pronounced symptomatic benefits are observed following treatments providing greater deobstructive effect. In detail, patients undergoing surgery exhibit greater IPSS and BOOI improvements than those receiving medical therapy.
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Affiliation(s)
- Massimiliano Creta
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Naples, Italy.
| | - Giorgio I Russo
- Urology Section, Department of Surgery, University of Catania, Catania, Italy
| | - Naeem Bhojani
- Division of Urology, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Marcus J Drake
- Department of Surgery and Cancer, Imperial College London, Hammersmith Hospital, London, UK
| | - Christian Gratzke
- Department of Urology, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Benoit Peyronnet
- Department of Urology, Rennes Academic Hospital, University of Rennes, Rennes, France
| | - Claus Roehrborn
- Department of Urology, UT Southwestern Medical Center, Dallas, TX, USA
| | - Kari A O Tikkinen
- Department of Urology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland; Department of Surgery, South Karelian Central Hospital, Lappeenranta, Finland; Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada
| | | | - Ferdinando Fusco
- Department of Woman, Child and General and Specialized Surgery, University of Campania 'Luigi Vanvitelli', Naples, Italy
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Brandt TW, Luizzi JM, Caras RJ. Evaluation of Current Surgical BPH Interventions for Young and Elderly Men. Curr Urol Rep 2024; 25:79-91. [PMID: 38470547 DOI: 10.1007/s11934-024-01198-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/12/2024] [Indexed: 03/14/2024]
Abstract
PURPOSE OF REVIEW Benign prostatic hyperplasia affects the quality of life of a significant number of men, especially as they age. There are continuous innovations in the surgical management of benign prostatic hyperplasia, but many of these innovations are studied in the core population of men 50-70 years of age. This review focuses on the outliers of men aged 18-50 and 70 and older. RECENT FINDINGS Older populations have more comorbidities, higher rates of antithrombotic medications, and advanced symptoms. Properly selected older men can safely have significant objective and subjective improvement in their symptoms. The literature was scarce when evaluating younger men; however, ejaculatory preserving techniques are promising providing improvement in symptoms and preserving ejaculation. This review demonstrates that in properly selected elderly patients, improvements in quality of life while also providing safe surgical interventions can be achieved. Ejaculatory preservation techniques demonstrate promising results, but further studies are required to elucidate true outcomes.
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Affiliation(s)
- Timothy W Brandt
- Department of Urology, Madigan Army Medical Center, 9040A Jackson Ave, Tacoma, WA, 98431, USA
| | - Jacqueline M Luizzi
- Department of Education and Research, Madigan Army Medical Center, Tacoma, WA, USA
| | - Ronald J Caras
- Department of Urology, Madigan Army Medical Center, 9040A Jackson Ave, Tacoma, WA, 98431, USA.
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Salem J, Becher KF, Bschleipfer T, Dreikorn K, Höfner K, Madersbacher S, Magistro G, Muschter R, Oelke M, Reich O, Rieken M, Schönburg S, Abt D. [Minimally invasive treatment of benign prostatic hyperplasia : The German S2e guideline 2023-part 4]. UROLOGIE (HEIDELBERG, GERMANY) 2024; 63:58-66. [PMID: 38193989 DOI: 10.1007/s00120-023-02249-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/22/2023] [Indexed: 01/10/2024]
Abstract
BACKGROUND Lower urinary tract symptoms suggestive for benign prostatic obstruction (LUTS/BPO) are one of the most frequent diseases in men and can have a significant impact on quality of life. Instrumental therapies are common, and many patients seek minimally invasive treatment options. OBJECTIVE Presentation and evidence-based evaluation of the minimally invasive therapy for benign prostatic syndrome. MATERIALS AND METHODS Summary and overview of chapters 11-13 on minimally invasive therapies for LUTS/BPO of the current long version of the German S2e guideline. RESULTS In case of absolute indication for surgery or after unsatisfactory or undesired medical therapy, minimally invasive treatments such as UroLift® (Neotract Inc., Pleasanton, CA, USA), Rezῡm™ (Boston Scientific, Malborough, MA, USA), iTIND™ (Olympus America Inc., Westborough, MA, USA), and prostatic artery embolization (PAE) can be considered. These indirect/delayed ablative therapies offer lower morbidity and the possibility of performing them under local anesthesia, but they are inferior to direct ablative/resective techniques in terms of effectiveness and sustainability. CONCLUSIONS The updated German S2e guideline summarizes evidence-based recommendations for new minimally invasive therapies for LUTS/BPO, which present alternative treatment options for selected patients.
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Affiliation(s)
- Johannes Salem
- CUROS urologisches Zentrum, Klinik LINKS VOM RHEIN, Schillingsrotterstr. 39-41, 50996, Köln, Deutschland.
- Klinik für Urologie und Kinderurologie, Universitätsklinikum Brandenburg a.d. Havel, MHB Brandenburg Theodor Fontane, Brandenburg a.d. Havel, Deutschland.
| | - Klaus F Becher
- Klinik für Rehabilitation, Klinik Wartenberg Professor Dr. Selmair GmbH & Co. KG, Wartenberg, Deutschland
| | - Thomas Bschleipfer
- Klinik für Urologie und Kinderurologie, Regiomed Klinikum, Coburg, Deutschland
| | | | - Klaus Höfner
- Klinik für Urologie, Evangelisches Krankenhaus, Oberhausen, Deutschland
| | | | - Giuseppe Magistro
- Klinik für Urologie, Asklepios Westklinikum GmbH, Hamburg, Deutschland
| | - Rolf Muschter
- Urologische Abteilung, ALTA Klinik, Bielefeld, Deutschland
| | - Matthias Oelke
- Klinik für Urologie, St. Antonius-Hospital GmbH, Gronau, Deutschland
| | | | | | - Sandra Schönburg
- Universitätsklinik und Poliklinik für Urologie und Nierentransplantation, Martin-Luther-Universität, Halle-Wittenberg, Deutschland
| | - Dominik Abt
- Klinik für Urologie, Spitalzentrum, Biel, Schweiz
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Long-term outcomes of prostate artery embolization for acute urinary retention: An analysis of 88 patients. Diagn Interv Imaging 2023; 104:292-296. [PMID: 36801097 DOI: 10.1016/j.diii.2023.01.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 01/27/2023] [Accepted: 01/31/2023] [Indexed: 02/18/2023]
Abstract
PURPOSE The purpose of this study was to assess long-term outcome of prostate artery embolization (PAE) in patients presenting with acute urinary retention related to benign prostatic hyperplasia. MATERIALS AND METHODS All consecutive patients who underwent PAE for acute urinary retention due to benign prostatic hyperplasia from August 2011 to December 2021 in a single institution were retrospectively included. There were 88 men with a mean age of 72 ± 12 (standard deviation [SD]) years (range: 42-99 years). Patients underwent a first attempt of catheter removal two weeks after PAE. Clinical success was defined as the absence of acute urinary retention recurrence. Correlations between long-term clinical success and patient variables or bilateral PAE were searched for using Spearman correlation test. Catheter-free survival was assessed using Kaplan-Meier analysis. RESULTS Successful catheter removal in the month following PAE was performed in 72 (72/88; 82%) patients and 16 (16/88; 18%) patients had immediate recurrence. Clinical success persisted for 58 (58/88; 66%) patients at long-term follow-up (mean follow-up: 19.5 months ± 16.5 [SD]; range: 2-74 months). Recurrence occurred at a mean of 16.2 months ± 12.2 (SD) (range: 1.5-43 months) post-PAE. Overall, 21 (21/88; 24%) patients of the cohort underwent prostatic surgery, at a mean of 10.4 months ± 12.2 (SD) (range: 1.2-42.4 months) from initial PAE. No correlations between patients variables or bilateral PAE and long-term clinical success were identified. Kaplan-Meier analysis showed a three-year catheter free probability of 60%. CONCLUSION PAE is a valuable technique for acute urinary retention related to benign prostatic hyperplasia, with a long-term success rate of 66%. However acute urinary retention relapse affects 15% of patients.
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Mahmoudi M, Jennings C, Pereira K, Hall AF, Arzani A. Guiding the prostatic artery embolization procedure with computational uid dynamics. J Biomech Eng 2022; 144:1140781. [DOI: 10.1115/1.4054515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Indexed: 11/08/2022]
Abstract
Abstract
Benign prostatic hyperplasia (BPH) is a common disease associated with lower urinary tract symptoms and the most frequent benign tumor in men. To reduce BPH therapy complications, prostatic artery embolization (PAE) was developed to replace the surgical options. PAE is a minimally invasive technique in which emboli are injected into the prostate arteries (PA), obstructing the blood flow in the hypervascular nodules. In this work, a personalized PAE treatment strategy was proposed using patient-specific computational fluid dynamics (CFD). First, the hemodynamics environment in the iliac arterial tree considering a large network of bifurcations was studied. The results showed complex blood flow patterns in the iliac arterial network. Subsequently, the transport of embolic particulates during PAE for the standard horizontal and a hypothetical vertical patient positioning was simulated using Lagrangian particle tracking. Emboli with different sizes were released at various locations across the iliac arterial tree. The emboli entering the PA were mapped back to their initial location to create emboli release maps (ERMs). The obtained ERMs during the standard patient positioning for smaller emboli at certain release locations showed distinct regions in which if the emboli were released within these regions, all of them would reach the PA without non-target embolization. During the hypothetical vertical patient positioning, the larger emboli formed a larger coherent region in the ERMs. Our patient-specific model can be used to find the best spatial location for emboli injection and perform the embolization procedure with minimal off-target delivery.
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Affiliation(s)
- Mostafa Mahmoudi
- Department of Mechanical Engineering, Northern Arizona University, Flagstaff, AZ, United States
| | - Chadrick Jennings
- Department of Mechanical Engineering, Northern Arizona University, Flagstaff, AZ, United States
| | - Keith Pereira
- Department of Radiology, Saint Louis University, St Louis, MO, United States
| | - Andrew F. Hall
- Department of Biomedical Engineering, Saint Louis University, St Louis, MO, United States
| | - Amirhossein Arzani
- Department of Mechanical Engineering, Northern Arizona University, Flagstaff, AZ, United States
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Sampogna G, Barbosa F, Brambillasca PM, Montanari E, Rampoldi A, Spinelli M. Prostatic artery embolization in people with spinal cord injury: a safe and effective technique to ease intermittent catheterization in case of concomitant benign prostatic hyperplasia. Spinal Cord Ser Cases 2022; 8:34. [PMID: 35332117 PMCID: PMC8948271 DOI: 10.1038/s41394-022-00499-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Revised: 02/18/2022] [Accepted: 02/20/2022] [Indexed: 11/09/2022] Open
Abstract
STUDY DESIGN Case series. OBJECTIVES To assess the safety and efficacy of prostatic artery embolization (PAE) to reduce prostate volume (PV) and facilitate intermittent catheterization (IC) in individuals with concurrent benign prostatic hyperplasia (BPH) and spinal cord injury (SCI). SETTING Italian tertiary referral center for people with SCI. METHODS We retrospectively collected all data of individuals undergoing PAE from 2015 to 2020 because of BPH-related problems during IC. PAE was performed under local anesthesia with superselective catheterization of the prostatic arteries. Technical success was defined as bilateral embolization. We determined pre- and post-procedural PV by magnetic resonance imaging. RESULTS We considered 10 cases with tetraplegia (n = 5) and paraplegia (n = 5). Nine (90%) procedures were technically successful, while we performed monolateral PAE in one case. The median pre-procedural PV was 61 mL. After 6 months, all patients experienced significant PV reduction (median: 19.6%), and 7/7 patients with indwelling urinary catheter started successfully IC. Neither intra- nor post-procedural complications occurred within a median follow-up of 33 months. CONCLUSIONS PAE proved to be a safe and effective treatment for BPH to facilitate IC in people with SCI. Considering the minimal morbidity of PAE, further multi-center studies are mandatory to draw definitive conclusions and warrant its widespread adoption in this population.
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Affiliation(s)
- Gianluca Sampogna
- Unit of Neuro-Urology - Unipolar Spinal Unit, Niguarda Hospital, Milan, Italy
- Unit of Urology, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Fabiane Barbosa
- Unit of Interventional Radiology, Niguarda Hospital, Milan, Italy
| | | | - Emanuele Montanari
- Unit of Urology, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Antonio Rampoldi
- Unit of Interventional Radiology, Niguarda Hospital, Milan, Italy
| | - Michele Spinelli
- Unit of Neuro-Urology - Unipolar Spinal Unit, Niguarda Hospital, Milan, Italy.
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Insausti I, Galbete A, Lucas-Cava V, de Ocáriz AS, Solchaga S, Monreal R, de la Cuesta AM, Alfaro R, Sun F, Montesino M, Urtasun F, Bilbao Jaureguízar JI. Prostatic Artery Embolization (PAE) Using Polyethylene Glycol Microspheres: Safety and Efficacy in 81 Patients. Cardiovasc Intervent Radiol 2022; 45:1339-1348. [PMID: 35655035 PMCID: PMC9458568 DOI: 10.1007/s00270-022-03165-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Accepted: 04/26/2022] [Indexed: 01/26/2023]
Abstract
PURPOSE To evaluate the safety and efficacy of prostatic artery embolization (PAE) using polyethylene glycol microspheres (PEGM) in patients with lower urinary tract symptoms secondary to benign prostatic hyperplasia (BPH). MATERIALS AND METHODS This multicentric prospective study enrolled 81 patients who underwent PAE with 400 ± 75 µm PEGM (HydroPearl®, Terumo, Japan). Results from baseline and 1-, 3-, 6-, and 12-month follow-ups were assessed for subjective outcomes including International Prostate Symptoms Score (IPSS), Quality of life (QoL), and International Index of Erectile Function, and objective outcomes such as peak urinary flow (Qmax) and post-void residual volume (PVR). The visual analogue scale, satisfaction questionnaire, prostatic volume, and prostatic specific antigen levels were also evaluated. Complications were documented using the modified Clavien-Dindo classification. RESULTS Technical success was obtained in all patients. Clinical success was achieved in 78.5% of patients. Before PAE, 54.3% of patients had an indwelling catheter which was removed in 75% of them after procedure. A statistically significant decrease was observed in IPSS and QoL from baseline to 12 months (20.14 vs 5.89; 4.8 vs 0.63, P < .01), respectively. Objective outcomes also showed a statistically significant improvement in Qmax (+ 114.9%; P < .01), achieving a maximum urinary flow of 14.2 mL/sec, and PVR (decrease 58%; P < .05) at 12 months. Minor complications (Clavien-Dindo grades I-II) occurred in 13.6% of patients, without major complications observed. CONCLUSION PAE with PEGM is safe and effective treatment in patients with symptomatic BPH, with a significant improvement in both subjective and objective outcomes.
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Affiliation(s)
- Iñigo Insausti
- Department of Interventional Radiology, Hospital Universitario de Navarra, Pamplona, Spain
| | - Arkaitz Galbete
- Universidad Pública de Navarra–Navarrabiomed–Hospital Universitario de Navarra, Redissec, Instituto de Investigacion Sanitaria de Navarra (IdiSNA), Pamplona, Spain
| | - Vanesa Lucas-Cava
- Endoluminal Therapy and Diagnosis Unit, Jesús Usón Minimally Invasive Surgery Centre, Cáceres, Spain
| | - Ana Sáez de Ocáriz
- Department of Interventional Radiology, Hospital Universitario de Navarra, Pamplona, Spain
| | - Saioa Solchaga
- Department of Interventional Radiology, Hospital Universitario de Navarra, Pamplona, Spain
| | - Raquel Monreal
- Department of Interventional Radiology, Hospital Universitario de Navarra, Pamplona, Spain
| | | | - Raquel Alfaro
- Servicio Navarro de Salud, Osasunbidea, Pamplona, Spain
| | - Fei Sun
- Endoluminal Therapy and Diagnosis Unit, Jesús Usón Minimally Invasive Surgery Centre, Cáceres, Spain
| | - Manuel Montesino
- Department of Urology. Hospital, Universitario de Navarra, Pamplona, Spain
| | - Fermin Urtasun
- Department of Interventional Radiology, Hospital Universitario de Navarra, Pamplona, Spain
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Culp WTN, Johnson EG, Giuffrida MA, Palm CA, Skorupski KA, Burton JH, Rebhun RB, Willcox JL, Kent MS, Rodriguez CO, Glaiberman CB. Procedural description and prospective evaluation of short-term outcome for the use of prostatic artery embolization in dogs with carcinoma of the prostate. J Am Vet Med Assoc 2021; 259:1154-1162. [PMID: 34727073 DOI: 10.2460/javma.20.06.0324] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To describe the procedure of prostatic artery embolization (PAE) in dogs with prostatic carcinoma and to evaluate the short-term outcome for treated dogs. ANIMALS 20 client-owned dogs with prostatic carcinomas between May 2014 and July 2017. PROCEDURES In this prospective cohort study, dogs with carcinoma of the prostate underwent PAE with fluoroscopic guidance. Before and after PAE, dogs underwent CT and ultrasonographic examinations of the prostate, and each owner completed a questionnaire about the dog's clinical signs. Results for before versus after PAE were compared. RESULTS Prostatic artery embolization was successfully performed in all 20 dogs. Tenesmus, stranguria, and lethargy were significantly less common 30 days after PAE (n = 2, 1, and 0 dogs, respectively), compared with before PAE (9, 10, and 6 dogs, respectively). Median prostatic volume was significantly less 30 days after PAE (14.8 cm3; range, 0.4 to 48.1 cm3; interquartile [25th to 75th percentile] range, 6.7 to 19.5 cm3), compared with before PAE (21.7 cm3; range, 2.9 to 77.7 cm3; interquartile range, 11.0 to 35.1 cm3). All dogs had a reduction in prostatic volume after PAE, with a median prostatic volume loss of 39.4% (95% CI, 20.3% to 59.3%). CONCLUSIONS AND CLINICAL RELEVANCE Prostatic artery embolization was associated with decreased prostate volume and improved clinical signs in this cohort. The short-term response to PAE appears promising, and evaluation of the long-term impact on survival time is needed.
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Prostate Artery Embolization-Review of Indications, Patient Selection, Techniques and Results. J Clin Med 2021; 10:jcm10215139. [PMID: 34768659 PMCID: PMC8584630 DOI: 10.3390/jcm10215139] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 10/27/2021] [Accepted: 10/29/2021] [Indexed: 12/28/2022] Open
Abstract
Lower urinary tract symptoms (LUTS) due to benign prostatic hypertrophy (BPH) are a very common problem in men ranging from mild urinary symptoms to recurrent urinary tract infections or renal failure. Numerous treatment options are available ranging from conservative medical therapies to more invasive surgical options. Prostate artery embolization (PAE) has emerged as a novel treatment option for this common problem with clinical efficacy comparable to the current surgical gold standard, transurethral resection of the prostate (TURP). PAE offers fewer complications and side effects without a need for general anesthesia or hospitalization. This review discusses the indications for prostate artery embolization in addition to LUTS, patient evaluation in patients with LUTS, PAE technique and clinical results, with an emphasis on efficacy and safety.
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10
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New Ultra-minimally Invasive Surgical Treatment for Benign Prostatic Hyperplasia: A Systematic Review and Analysis of Comparative Outcomes. EUR UROL SUPPL 2021; 33:28-41. [PMID: 34604814 PMCID: PMC8473553 DOI: 10.1016/j.euros.2021.08.009] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Context Benign prostatic hyperplasia (BPH) associated with lower urinary tract symptoms (LUTS) is diagnosed in up to 80% of men during their lifetime. Several novel ultra-minimally invasive surgical treatments (uMISTs) for BPH/benign prostatic obstruction (BPO) have become available over the past 5 yr. Objective To evaluate the perioperative and functional outcomes of recently introduced uMISTs for BPH/BPO, including Urolift, Rezūm, temporary implantable nitinol device, prostatic artery embolization (PAE), and intraprostatic injection. Evidence acquisition A systematic literature search was conducted in December 2020 using Medline (via PubMed), Embase (via Ovid), Scopus, and Web of Science (registered on PROSPERO as CRD42021225014). The search strategy used PICO criteria and article selection was conducted in accordance with the PRISMA guidelines. The risk of bias and the quality of the articles included were assessed. A dedicated data extraction form was used to collect the data of interest. Pooled and cumulative analyses were performed to compare perioperative and functional outcomes between study groups. A random-effects model using the DerSimonian and Laird method was used to evaluate heterogeneity. Stata version 15.0 software was used for all statistical analyses. Evidence synthesis The initial electronic search identified 3978 papers, of which 48 ultimately met the inclusion criteria and were included in the analysis. Pooled analysis revealed a uMIST benefit in terms of International Prostate Symptom Score (IPSS; −9.81 points, 95% confidence interval [CI] −11.37 to −8.25 at 1 mo; −13.13 points, 95% CI −14.98 to −11.64 at 12 mo), maximum flow rate (from +3.66 ml/s, 95% CI 2.8–4.5 to +4.14 ml/s, 95% CI 0.72–7.56 at 12 mo), and postvoid residual volume (−10.10 ml, 95% CI −27.90 to 7.71 at 12 mo). No negative impact was observed on scores for the International Index of Erectile Function-5, Male Sexual Health Questionnaire-Ejaculatory Dysfunction bother and function scales (overall postintervention change in pooled median score of 1.88, 95% CI 1.34–2.42 at the start of follow-up; and 1.04, 95% CI 0.28–1.8 after 1 yr), or the IPSS-Quality of Life questionnaire. Conclusions Novel uMISTs can yield fast and effective relief of LUTS without affecting patient quality of life. Only Rezūm, UroLift, and PAE had a minimal impact on patients’ sexual function with respect to baseline, especially regarding preservation of ejaculation. Patient summary We reviewed outcomes for recently introduced ultra-minimally invasive surgical treatments for patients with lower urinary tract symptoms caused by benign prostate enlargement or obstruction. The evidence suggests that these novel techniques are beneficial in terms of controlling symptoms while preserving sexual function. Take Home Message Novel ultra-minimally invasive treatments can yield fast and effective relief of lower urinary tract symptoms without affecting a patient’s quality of life.
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Dias US, de Moura MRL, Viana PCC, de Assis AM, Marcelino ASZ, Moreira AM, Leite CC, Cerri GG, Carnevale FC, Horvat N. Prostatic Artery Embolization: Indications, Preparation, Techniques, Imaging Evaluation, Reporting, and Complications. Radiographics 2021; 41:1509-1530. [PMID: 34415807 DOI: 10.1148/rg.2021200144] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Benign prostatic hyperplasia (BPH) is a noncancerous growth of the transitional zone of the prostate, which surrounds the prostatic urethra. Consequently, it can cause lower urinary tract symptoms (LUTS) and bladder outlet obstruction symptoms that may substantially reduce a patient's quality of life. Several treatments are available for BPH, including medications such as α-blockers and 5α-reductase inhibitors and surgical options including transurethral resection of the prostate and prostatectomy. Recently, prostatic artery embolization (PAE) has emerged as a minimally invasive treatment option for selected men with BPH and moderate to severe LUTS. Adequate pre- and postprocedural evaluations with clinical examinations and questionnaires, laboratory tests, and urodynamic and imaging examinations (particularly US, MRI, and CT) are of key importance to achieve successful treatment. Considering that the use of PAE has been increasing in tertiary hospital facilities, radiologists and interventional radiologists should be aware of the main technical concepts of PAE and the key features to address in imaging reports in pre- and postprocedural settings. An invited commentary by Lopera is available online. Online supplemental material is available for this article. ©RSNA, 2021.
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Affiliation(s)
- Ubenicio Silveira Dias
- From the Departments of Radiology (U.S.D., M.R.L.d.M., P.C.C.V., A.S.Z.M., C.C.L., G.G.C.) and Interventional Radiology (M.R.L.d.M., P.C.C.V., A.M.d.A., A.M.M., F.C.C.), Hospital Sírio-Libanês, Adma Jafet 91, Bela Vista, São Paulo, SP 01308-050, Brazil; Departments of Radiology (M.R.L.d.M., P.C.C.V., C.C.L., G.G.C.) and Interventional Radiology (M.R.L.d.M., P.C.C.V., A.M.d.A., A.M.M., F.C.C.), University of São Paulo, São Paulo, Brazil; and Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (N.H.)
| | - Maurício Ruettimann Liberato de Moura
- From the Departments of Radiology (U.S.D., M.R.L.d.M., P.C.C.V., A.S.Z.M., C.C.L., G.G.C.) and Interventional Radiology (M.R.L.d.M., P.C.C.V., A.M.d.A., A.M.M., F.C.C.), Hospital Sírio-Libanês, Adma Jafet 91, Bela Vista, São Paulo, SP 01308-050, Brazil; Departments of Radiology (M.R.L.d.M., P.C.C.V., C.C.L., G.G.C.) and Interventional Radiology (M.R.L.d.M., P.C.C.V., A.M.d.A., A.M.M., F.C.C.), University of São Paulo, São Paulo, Brazil; and Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (N.H.)
| | - Publio Cesar Cavalcante Viana
- From the Departments of Radiology (U.S.D., M.R.L.d.M., P.C.C.V., A.S.Z.M., C.C.L., G.G.C.) and Interventional Radiology (M.R.L.d.M., P.C.C.V., A.M.d.A., A.M.M., F.C.C.), Hospital Sírio-Libanês, Adma Jafet 91, Bela Vista, São Paulo, SP 01308-050, Brazil; Departments of Radiology (M.R.L.d.M., P.C.C.V., C.C.L., G.G.C.) and Interventional Radiology (M.R.L.d.M., P.C.C.V., A.M.d.A., A.M.M., F.C.C.), University of São Paulo, São Paulo, Brazil; and Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (N.H.)
| | - André Moreira de Assis
- From the Departments of Radiology (U.S.D., M.R.L.d.M., P.C.C.V., A.S.Z.M., C.C.L., G.G.C.) and Interventional Radiology (M.R.L.d.M., P.C.C.V., A.M.d.A., A.M.M., F.C.C.), Hospital Sírio-Libanês, Adma Jafet 91, Bela Vista, São Paulo, SP 01308-050, Brazil; Departments of Radiology (M.R.L.d.M., P.C.C.V., C.C.L., G.G.C.) and Interventional Radiology (M.R.L.d.M., P.C.C.V., A.M.d.A., A.M.M., F.C.C.), University of São Paulo, São Paulo, Brazil; and Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (N.H.)
| | - Antônio Sérgio Zanfred Marcelino
- From the Departments of Radiology (U.S.D., M.R.L.d.M., P.C.C.V., A.S.Z.M., C.C.L., G.G.C.) and Interventional Radiology (M.R.L.d.M., P.C.C.V., A.M.d.A., A.M.M., F.C.C.), Hospital Sírio-Libanês, Adma Jafet 91, Bela Vista, São Paulo, SP 01308-050, Brazil; Departments of Radiology (M.R.L.d.M., P.C.C.V., C.C.L., G.G.C.) and Interventional Radiology (M.R.L.d.M., P.C.C.V., A.M.d.A., A.M.M., F.C.C.), University of São Paulo, São Paulo, Brazil; and Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (N.H.)
| | - Airton Mota Moreira
- From the Departments of Radiology (U.S.D., M.R.L.d.M., P.C.C.V., A.S.Z.M., C.C.L., G.G.C.) and Interventional Radiology (M.R.L.d.M., P.C.C.V., A.M.d.A., A.M.M., F.C.C.), Hospital Sírio-Libanês, Adma Jafet 91, Bela Vista, São Paulo, SP 01308-050, Brazil; Departments of Radiology (M.R.L.d.M., P.C.C.V., C.C.L., G.G.C.) and Interventional Radiology (M.R.L.d.M., P.C.C.V., A.M.d.A., A.M.M., F.C.C.), University of São Paulo, São Paulo, Brazil; and Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (N.H.)
| | - Claudia Costa Leite
- From the Departments of Radiology (U.S.D., M.R.L.d.M., P.C.C.V., A.S.Z.M., C.C.L., G.G.C.) and Interventional Radiology (M.R.L.d.M., P.C.C.V., A.M.d.A., A.M.M., F.C.C.), Hospital Sírio-Libanês, Adma Jafet 91, Bela Vista, São Paulo, SP 01308-050, Brazil; Departments of Radiology (M.R.L.d.M., P.C.C.V., C.C.L., G.G.C.) and Interventional Radiology (M.R.L.d.M., P.C.C.V., A.M.d.A., A.M.M., F.C.C.), University of São Paulo, São Paulo, Brazil; and Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (N.H.)
| | - Giovanni Guido Cerri
- From the Departments of Radiology (U.S.D., M.R.L.d.M., P.C.C.V., A.S.Z.M., C.C.L., G.G.C.) and Interventional Radiology (M.R.L.d.M., P.C.C.V., A.M.d.A., A.M.M., F.C.C.), Hospital Sírio-Libanês, Adma Jafet 91, Bela Vista, São Paulo, SP 01308-050, Brazil; Departments of Radiology (M.R.L.d.M., P.C.C.V., C.C.L., G.G.C.) and Interventional Radiology (M.R.L.d.M., P.C.C.V., A.M.d.A., A.M.M., F.C.C.), University of São Paulo, São Paulo, Brazil; and Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (N.H.)
| | - Francisco Cesar Carnevale
- From the Departments of Radiology (U.S.D., M.R.L.d.M., P.C.C.V., A.S.Z.M., C.C.L., G.G.C.) and Interventional Radiology (M.R.L.d.M., P.C.C.V., A.M.d.A., A.M.M., F.C.C.), Hospital Sírio-Libanês, Adma Jafet 91, Bela Vista, São Paulo, SP 01308-050, Brazil; Departments of Radiology (M.R.L.d.M., P.C.C.V., C.C.L., G.G.C.) and Interventional Radiology (M.R.L.d.M., P.C.C.V., A.M.d.A., A.M.M., F.C.C.), University of São Paulo, São Paulo, Brazil; and Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (N.H.)
| | - Natally Horvat
- From the Departments of Radiology (U.S.D., M.R.L.d.M., P.C.C.V., A.S.Z.M., C.C.L., G.G.C.) and Interventional Radiology (M.R.L.d.M., P.C.C.V., A.M.d.A., A.M.M., F.C.C.), Hospital Sírio-Libanês, Adma Jafet 91, Bela Vista, São Paulo, SP 01308-050, Brazil; Departments of Radiology (M.R.L.d.M., P.C.C.V., C.C.L., G.G.C.) and Interventional Radiology (M.R.L.d.M., P.C.C.V., A.M.d.A., A.M.M., F.C.C.), University of São Paulo, São Paulo, Brazil; and Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (N.H.)
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Role of Ultrasound Elastography in Patient Selection for Prostatic Artery Embolization. J Vasc Interv Radiol 2021; 32:1410-1416. [PMID: 34333109 DOI: 10.1016/j.jvir.2021.07.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 07/03/2021] [Accepted: 07/18/2021] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To determine the effects of prostatic artery embolization (PAE) on prostate elasticity as assessed using ultrasound elastography (US-E) and to describe baseline US-E's potential role in patient selection. MATERIALS AND METHODS This was a prospective investigation that included 20 patients undergoing PAE to treat lower urinary tract symptoms attributed to benign prostatic hyperplasia (BPH). US-E with measurement of the prostatic elastic modulus (EM) and shear wave velocity (SWV) was performed before PAE and at 1-month follow-up. Baseline, 3-month, and 1-year follow-up evaluations included prostate-specific antigen, uroflowmetry, pelvic magnetic resonance imaging, and clinical assessment using the International Prostate Symptom Score (IPSS) and quality of life (QoL) metrics. RESULTS Seventeen patients entered statistical analysis. US-E showed a significant reduction in mean prostatic EM (34.4 kPa vs 46.3 kPa, -24.7%, P < .0001) and SWV (3.55 m/s vs 4.46 m/s, -20.0%, P < .0001) after PAE. There were moderate positive correlations between baseline EM and 1-year IPSS (R = 0.62, P = .007) and between baseline SWV and 1-year IPSS (R = 0.68, P = .002). Baseline SWV ≥ 5.59 m/s and baseline EM ≥ 50.14 kPa were associated with suboptimal IPSS and QoL outcomes after PAE with high degrees of sensitivity (100%) and specificity (69-100%). CONCLUSIONS PAE led to a positive effect on the BPH dynamic component related to prostatic elasticity. There was a moderate positive correlation between baseline prostatic elastographic parameters and 12-month IPSS. Measurement of baseline elastographic characteristics may become useful for the evaluation and selection of patients for PAE.
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Salvador Hidalgo D, Bernardello Ureta M, Sbriglio M, García Gámez A, Sampere Moragas J, Areal Calama J, Ágreda Castañeda F. Prostatic artery embolization treatment for patients with benign prostatic hyperplasia who are permanent urinary catheter users ineligible for de-obstructive surgery. Actas Urol Esp 2021; 45:481-485. [PMID: 34326030 DOI: 10.1016/j.acuroe.2021.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 04/02/2021] [Indexed: 11/16/2022]
Abstract
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.
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Affiliation(s)
| | | | - M Sbriglio
- Servicio de Urología, Hospital Germans Trias i Pujol, Barcelona, Spain
| | - A García Gámez
- Servicio de Radiología Intervencionista, Hospital Germans Trias i Pujol, Barcelona, Spain
| | - J Sampere Moragas
- Servicio de Radiología Intervencionista, Hospital Germans Trias i Pujol, Barcelona, Spain
| | - J Areal Calama
- Servicio de Urología, Hospital Germans Trias i Pujol, Barcelona, Spain
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14
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Prostatic artery embolization treatment for patients with benign prostatic hyperplasia who are permanent urinary catheter users ineligible for de-obstructive surgery. Actas Urol Esp 2021. [PMID: 33992446 DOI: 10.1016/j.acuro.2021.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
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.
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Zhaparov U, Khairli G, Zhanbyrbekuly U, Sushchenko A, Ainayev Y. Endovascular Superselective Embolization of the Prostatic Arteries in the Treatment of Benign Prostatic Hyperplasia. ELECTRONIC JOURNAL OF GENERAL MEDICINE 2021. [DOI: 10.29333/ejgm/10832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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16
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Leng B, Zhou CG, Liu S, Xu ZW, Tian W, Shi HB. Prostatic Artery Embolization to Achieve Freedom from Catheterization in Patients with Acute Urinary Retention Caused by Benign Prostatic Hyperplasia. J Vasc Interv Radiol 2021; 32:1062-1067. [PMID: 33794374 DOI: 10.1016/j.jvir.2021.03.530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 03/12/2021] [Accepted: 03/20/2021] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To determine the ability of prostatic artery embolization (PAE) to achieve freedom from catheterization in patients with acute urinary retention (AUR) caused by benign prostatic hyperplasia (BPH). MATERIALS AND METHODS This retrospective single-center study was performed between June 2014 and March 2019 in patients with lower urinary tract symptoms (LUTS) caused by BPH. PAE was performed in 154 eligible patients, of which 76 suffered from spontaneous AUR and had indwelling catheters placed and kept until the procedure, owing to clinical failure in the removal of the previous intermittent catheter. Each patient was followed for at least 12 months. The first trial without catheter was performed 3 days after PAE. Successful catheter removal within the first 30 days after PAE was considered a clinical success. The rate of patients free from catheterization, LUTS relief, prostate volume, and adverse events was recorded. RESULTS Clinical success was achieved in 70 (92.1%) patients. The rates of freedom from catheterization were 90.3% (65/72), 83.3% (60/72), and 80.6% (58/72) at 3-, 6-, and 12-months follow-up, respectively. The median elapsed time from PAE to catheter removal was 10 days. However, 18 patients needed further interventions. Symptom scores revealed a continuous improvement in urinary symptoms. The mean prostate volume showed a statistically significant decrease at 3 and 12 months compared with its baseline value. No severe adverse events occurred. CONCLUSIONS PAE can achieve freedom from catheterization in patients with AUR caused by BPH.
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Affiliation(s)
- Bin Leng
- Department of Interventional Radiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Chun-Gao Zhou
- Department of Interventional Radiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Sheng Liu
- Department of Interventional Radiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Zhong-Wei Xu
- Department of Interventional Radiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Wei Tian
- Department of Interventional Radiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China.
| | - Hai-Bin Shi
- Department of Interventional Radiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China.
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Neymark AI, Karpenko AA, Neymark BA, Tachalov MA, Arzamastsev DD, Torbik DV, Gameeva EV, Bobrov BY, Spivak LG, Korolev DO, Tsarichenko DG, Rapoport LM. Superselective prostatic artery embolization in the treatment of large benign prostatic hyperplasia. Urologia 2021; 88:374-381. [PMID: 33550913 DOI: 10.1177/0391560321993598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE To evaluate the use of prostatic artery embolization (PAE) as a treatment option for patients with symptomatic benign prostatic hyperplasia (BPH) with prostate volumes of 80 cc and more. MATERIALS AND METHODS The study included 75 patients with high anesthesia-related risks for conventional surgery (TURP). All patients were surveyed for symptom burden, using IPSS and quality of life score. The prostate volume was determined by transrectal ultrasonography (TRUS). At baseline, prostate-specific antigen (PSA) level was obtained in all patients. Urodynamics was evaluated using uroflowmetry. Clinical outcomes were assessed at follow-up 1, 3, 6, 12, and 24 months after PAE. RESULTS The prostate volume decreased significantly at months 1 and 3 post-treatment; the prostate continued shrinking until month 12, and the size was then stabilized. At month 24, prostate volume decreased by 40.82%, from 134.0 ± 8.3 mL at baseline to 79.3 ± 6.6 mL. Postvoid residual (PVR) urine volume was significantly decreased from 55.9 ± 5.3 mL to 22.0 ± 1.8 mL 1 month after PAE (p < 0.001). Qmax increased from 9.2 ± 0.3 mL/s to 15.7 ± 0.4 mL/s. IPSS score following PAE decreased from 28.2 ± 0.7 to 9.7 ± 0.8 (p < 0.001). QoL improvement was observed from 4.8 ± 0.2 at baseline to 1.8 ± 0.2 at month 24 (p < 0.001). Decreased activity and density of adenomatous tissue resulted in decreased total PSA levels: from 5.9 ± 1.1 ng/mL to 2.6 ± 0.2 ng/mL (p < 0.001). TURP became feasible in 35 patients due to reduction of prostate volumes below 80 mL after PAE. CONCLUSIONS PAE was effective in relieving LUTS and reducing prostate size, and may be considered as a preoperative approach for patients with large prostate.
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Affiliation(s)
- Alexander Izrailevich Neymark
- Department of Urology and Nephrology, Altai State Medical University (Federal State Budgetary Educational Institution of Higher Education), Barnaul, Russia
| | - Andrey Anatoljevich Karpenko
- E. Meshalkin National Medical Research Center, Ministry of Health of the Russian Federation, Novosibirsk, Russia
| | - Boris Alexandrovich Neymark
- Department of Urology and Nephrology, Altai State Medical University (Federal State Budgetary Educational Institution of Higher Education), Barnaul, Russia
| | - Mikhail Alexandrovich Tachalov
- Department of Urology and Nephrology, Altai State Medical University (Federal State Budgetary Educational Institution of Higher Education), Barnaul, Russia
| | - Denis Dmitrievich Arzamastsev
- Department of Urology and Nephrology, Altai State Medical University (Federal State Budgetary Educational Institution of Higher Education), Barnaul, Russia
| | - Demid Vjacheslavovich Torbik
- Department of Urology and Nephrology, Altai State Medical University (Federal State Budgetary Educational Institution of Higher Education), Barnaul, Russia
| | - Elena Vladimirovn Gameeva
- Federal State Budgetary Institution National Medical Research Radiological Center of the Ministry of Health of the Russian Federation, Moscow, Russia
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Richardson AJ, Acharya V, Kably I, Bhatia S. Prostatic Artery Embolization: Variant Origins and Collaterals. Tech Vasc Interv Radiol 2020; 23:100690. [PMID: 33308535 DOI: 10.1016/j.tvir.2020.100690] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Prostate artery embolization (PAE) is a minimally invasive treatment for benign prostatic hyperplasia associated lower urinary tract symptoms. The prostatic arterial anatomy, origins and collaterals, are highly variable and can lead to technical pitfalls and suboptimal results during PAE. In this paper we aim to discuss the variant prostate artery origins and collateral circulation to provide a primer on relevant anatomy for interventional radiologists performing PAE.
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Affiliation(s)
- Andrew J Richardson
- Department of Interventional and Diagnostic Radiology, Jackson Memorial Hospital, Miami, FL.
| | - Vedant Acharya
- University of Miami Miller School of Medicine, Miami, FL
| | - Issam Kably
- Department of Interventional Radiology, University of Miami Miller School of Medicine, Miami, FL
| | - Shivank Bhatia
- Department of Interventional Radiology, University of Miami Miller School of Medicine, Miami, FL
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Li X, Li B, Ullah MW, Panday R, Cao J, Li Q, Zhang Y, Wang L, Yang G. Water-stable and finasteride-loaded polyvinyl alcohol nanofibrous particles with sustained drug release for improved prostatic artery embolization — In vitro and in vivo evaluation. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2020; 115:111107. [DOI: 10.1016/j.msec.2020.111107] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 04/18/2020] [Accepted: 05/18/2020] [Indexed: 02/07/2023]
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Moschouris H, Dimakis A, Anagnostopoulou A, Stamatiou K, Malagari K. Sonographic evaluation of prostatic artery embolization: Far beyond size measurements. World J Radiol 2020; 12:172-183. [PMID: 32913563 PMCID: PMC7457160 DOI: 10.4329/wjr.v12.i8.172] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Revised: 05/02/2020] [Accepted: 07/01/2020] [Indexed: 02/06/2023] Open
Abstract
Prostatic artery embolization (PAE) has gained acceptance as a minimally invasive, safe and effective treatment of symptomatic benign prostatic hyperplasia. Radiologic imaging is an indispensable part of post-interventional evaluation of PAE and serves both clinical and investigational purposes. In this context, ultrasonography (US) has a central and multifaceted role. Gray-scale US is routinely utilized for measurement of significant outcome parameters (prostatic volume, intra-vesical prostatic protrusion and post-void residual volume) before and after PAE. Improvement of these parameters may become more obvious one-month post-PAE, or later. Contrast-enhanced US (CEUS) with intravenous administration of a second-generation echo-enhancer can demonstrate prostatic infarcts (as enhancement defects) immediately post-PAE and monitor their resolution over time. The volume of prostatic infarcts can also be measured and compared to prostatic volume. Prostatic infarction is a definite sign of the local efficacy of PAE and a predictor of prostate shrinkage and (at least in some patients) of clinical success. CEUS can also be performed intraoperatively in the angio-suite, for on-site evaluation of the ischemic effect; a variation of this technique, with intraarterial (instead of intravenous) administration of diluted echo enhancer, can also be applied intraoperatively, to map the embolized territory and to prevent non-target embolization. Initial experience with US-elastographic techniques (shear-wave and strain elastography) has shown that they can detect and quantify the improvement of tissue elasticity post-PAE, thus providing new insights into the therapeutic mechanisms of this treatment. With utilization of high-end equipment, experience and standardized imaging protocols, US could be the primary modality for imaging evaluation of PAE.
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Affiliation(s)
| | - Andreas Dimakis
- Radiology Department, General Hospital “Tzanio”, Piraeus 18536, Greece
| | | | | | - Katerina Malagari
- Second Department of Radiology, University of Athens, “Attikon” Hospital, Athens 12462, Greece
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21
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Sun F, Lucas-Cava V, Sánchez-Margallo FM. Clinical predictive factors in prostatic artery embolization for symptomatic benign prostatic hyperplasia: a comprehensive review. Transl Androl Urol 2020; 9:1754-1768. [PMID: 32944536 PMCID: PMC7475690 DOI: 10.21037/tau-20-437] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Prostatic artery embolization (PAE) has been established as a routine treatment for symptomatic benign prostatic hyperplasia (BPH) all over the world. With increasing clinical experience in the last decade, investigators have sufficient data to assess predictive factors with the purpose to guide patient selection and counseling for PAE or to individualize therapeutic plans after PAE. This paper is a comprehensive review to introduce the concept of clinical predictors and give a systemic classification of various predictive factors in PAE. The authors review each individual factor and its predictive capability and discuss the possible reasons for the inconsistent or conflicting findings in the literature. Based on current evidence, the baseline prostate volume, in particular the transition zone volume and transition zone index; 24 h post-PAE prostate-specific antigen (PSA) level; and prostate infarction and prostate volume reduction at 1–3 months have potential in prediction of treatment outcomes. Patients with Adenomatous-dominant BPH or with indwelling bladder catheter before PAE may have more benefits from PAE. Baseline intravesical prostatic protrusion (IPP), C-reactive protein (CRP) level at 48 h and early detection of prostate infarct at 1 day and 1 week after PAE need further investigating.
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Affiliation(s)
- Fei Sun
- Jesus Uson Minimally Invasive Surgery Centre, Caceres, Spain
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Malling B, Røder MA, Lauridsen C, Lönn L. Can Computed Tomography Perfusion Predict Treatment Response After Prostate Artery Embolization: A Feasibility Study. Diagnostics (Basel) 2020; 10:diagnostics10050304. [PMID: 32429192 PMCID: PMC7277883 DOI: 10.3390/diagnostics10050304] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 05/08/2020] [Accepted: 05/13/2020] [Indexed: 11/16/2022] Open
Abstract
Prostate artery embolization (PAE) is an emerging therapy for benign prostatic hyperplasia (BPH). Optimal patient selection is an important step when introducing new treatments and several characteristics associated with a good clinical outcome has previously been proposed. However, no prognostic tool is yet available for PAE. Computed tomography perfusion is an imaging technique that provides hemodynamic parameters making it possible to estimate the prostatic blood flow (PBF). This study investigated the relationship between PBF and the response to PAE. A post hoc analysis including prostate-specific antigen (PSA) measurements before and 24-h after embolization from two prospective studies on sixteen patients undergoing PAE with BPH or prostate cancer were performed. The primary outcome was the correlation between baseline PBF and the change in PSA as a surrogate measure of treatment response. Prostate volume strongly correlated with treatment response and the response was greater with incremental amounts of injected embolic material. PBF was not associated with elevation in PSA and added no information that could guide patient selection.
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Affiliation(s)
- Brian Malling
- Department of Diagnostic Radiology, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark; (B.M.); (C.L.); (L.L.)
| | - Martin Andreas Røder
- Department of Urology, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
- Correspondence:
| | - Carsten Lauridsen
- Department of Diagnostic Radiology, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark; (B.M.); (C.L.); (L.L.)
- Bachelor’s Degree Programme in Radiogeltraphy, Copenhagen University College, Sigurdsgade 26, 2200 Copenhagen, Denmark
| | - Lars Lönn
- Department of Diagnostic Radiology, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark; (B.M.); (C.L.); (L.L.)
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Monreal R, Robles C, Sánchez-Casado M, Ciampi J, López-Guerrero M, Ruíz-Salmerón R, Lanciego C. Embolisation of prostate arteries in benign prostatic hyperplasia in non-surgical patients. RADIOLOGIA 2020. [DOI: 10.1016/j.rxeng.2019.12.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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24
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Uflacker AB, Haskal ZJ, Baerlocher MO, Bhatia SS, Carnevale FC, Dariushnia SR, Faintuch S, Gaba RC, Golzarian J, Midia M, Nikolic B, Sapoval MR, Walker TG. Society of Interventional Radiology Research Reporting Standards for Prostatic Artery Embolization. J Vasc Interv Radiol 2020; 31:891-898.e1. [PMID: 32340862 DOI: 10.1016/j.jvir.2020.03.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 03/02/2020] [Indexed: 11/26/2022] Open
Affiliation(s)
- Andre B Uflacker
- Department of Radiology and Radiological Sciences, Division of Vascular and Interventional Radiology, Medical University of South Carolina, Charleston, South Carolina.
| | - Ziv J Haskal
- Department of Radiology and Medical Imaging/Interventional Radiology, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Mark O Baerlocher
- Department of Radiology, Royal Victoria Hospital, Barrie, Ontario, Canada
| | - Shivank S Bhatia
- Department of Interventional Radiology, University of Miami Miller School of Medicine, Miami, Florida
| | - Francisco C Carnevale
- Department of Interventional Radiology, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Sean R Dariushnia
- Department of Radiology and Imaging Sciences, Division of Interventional Radiology and Image-Guided Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Salomao Faintuch
- Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Ron C Gaba
- Department of Radiology, University of Illinois at Chicago, Chicago, Illinois
| | - Jafar Golzarian
- Department of Radiology, Division of Interventional Radiology and Vascular Imaging, University of Minnesota, Minneapolis, Minnesota
| | - Mehran Midia
- Department of Radiology, McMaster University, Joseph Brant Hospital, Burlington, Ontario, Canada
| | - Boris Nikolic
- Department of Interventional Radiology, Cooley Dickinson Hospital, Massachusetts General Hospital Affiliate, Northampton, Massachusetts
| | - Marc R Sapoval
- Department of Interventional Vascular and Oncologic Radiology, Hôpital Européen Georges Pompidou, Paris, France
| | - T Gregory Walker
- Division of Interventional Radiology, Massachusetts General Hospital, Boston, Massachusetts
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Lin YT, Pereira H, Pellerin O, Déan C, Thiounn N, Sapoval M. Four-Year Impact of Voiding and Storage Symptoms in Patients with Benign Prostatic Hyperplasia Treated with Prostatic Artery Embolization. J Vasc Interv Radiol 2020; 31:1460-1466. [PMID: 32107124 DOI: 10.1016/j.jvir.2019.08.034] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 08/19/2019] [Accepted: 08/31/2019] [Indexed: 12/15/2022] Open
Abstract
PURPOSE To study the subscore improvement in International Prostate Symptom Scores (IPSS) after prostatic artery embolization (PAE). MATERIALS AND METHODS A single-center retrospective study was carried out with follow-up from December 2013 to July 2019 in 37 consecutive patients (66.0 ± 8.8 years old) who underwent PAE, comparing resultant scores before and after PAE. IPSS were divided into storage (IPSS-s) subscores and voiding (IPSS-v) subscores. The changes between IPSS-s and IPSS-v at 1, 3, 6, and 12 months' follow-up as well as the last follow-up were compared with baseline scores. The changes in percentages of IPSS-s and IPSS-v and the changes in average IPSS-s-to-total IPSS ratios (IPSS-s/IPSS-t) and IPSS-v-to-IPSS-t ratios (IPSS-v/IPSS-t) were also analyzed. RESULTS In the study population, consisting of 37 patients, IPSS-t significantly decreased from 16.5 ± 7.2 at baseline to 8.3 ± 5.7 at the last follow-up (4 years later) (P < .0001). Additionally, the changes in IPSS-v symptoms were greater than the changes in IPSS-s symptoms at 1, 3, 6, and 12 months' follow-up, reaching a statistical significance at 6 months with a decrease of 72.9% ± 42.4% for IPSS-v and a decrease of 50.1% ± 52.2% for IPSS-s (P = .009). CONCLUSIONS PAE can successfully reduce both IPSS-s and IPSS-v with predominant IPSS-v reduction. The improvements in both subscores were sustained for up to 4 years of follow-up.
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Affiliation(s)
- Yen-Ting Lin
- Department of Interventional Radiology, Assistance publique Hopitaux de Paris, Hôpital Européen Georges-Pompidou, Paris, France; Department of Radiology, Taichung Veterans General Hospital, 1650 Taiwan Boulevard Sect., 40705 Taichung, Taiwan.
| | - Héléna Pereira
- Department of Interventional Radiology, Assistance publique Hopitaux de Paris, Hôpital Européen Georges-Pompidou, Paris, France
| | - Olivier Pellerin
- Department of Interventional Radiology, Assistance publique Hopitaux de Paris, Hôpital Européen Georges-Pompidou, Paris, France; Université Paris Descartes, Sorbonne Paris-Cité, Paris, France; Institut national de la santé et de la recherche médicale U970, Paris, France
| | - Carole Déan
- Department of Interventional Radiology, Assistance publique Hopitaux de Paris, Hôpital Européen Georges-Pompidou, Paris, France
| | - Nicolas Thiounn
- Department of Urology, Assistance publique Hopitaux de Paris, Hôpital Européen Georges-Pompidou, Paris, France
| | - Marc Sapoval
- Department of Interventional Radiology, Assistance publique Hopitaux de Paris, Hôpital Européen Georges-Pompidou, Paris, France; Université Paris Descartes, Sorbonne Paris-Cité, Paris, France; Institut national de la santé et de la recherche médicale U970, Paris, France
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CIRSE Standards of Practice on Prostatic Artery Embolisation. Cardiovasc Intervent Radiol 2019; 43:176-185. [DOI: 10.1007/s00270-019-02379-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 11/14/2019] [Indexed: 01/22/2023]
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27
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Monreal R, Robles C, Sánchez-Casado M, Ciampi JJ, López-Guerrero M, Ruíz-Salmerón RJ, Lanciego C. Embolisation of prostate arteries in benign prostatic hyperplasia in non-surgical patients. RADIOLOGIA 2019; 62:205-212. [PMID: 31757401 DOI: 10.1016/j.rx.2019.07.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 07/23/2019] [Accepted: 07/29/2019] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To present the results of a multidisciplinary study of two tertiary hospitals, together with urology services, on 102 consecutive patients not candidates for surgery treated for more than 6 years, in whom prostatic arteries were embolised for the treatment of benign hyperplasia. MATERIAL AND METHODS From December 2012 to February 2019, 102 patients with symptoms of benign prostatic hyperplasia (BPH) not candidates for surgery or who explicitly rejected surgery, with an average age of 73.9 years (range 47.5-94.5), underwent prostatic artery embolisation. The patients were followed up by questionnaires on urinary symptoms, sexual function and impact on quality of life, as well as measurement of prostate volume, uroflowmetry and prostate specific antigen (PSA) at one, 3 and 6 months and one year following the procedure. RESULTS The technique was successful in 96% of patients (76.2% bilateral and 19.8% unilateral). The mean duration of the procedure was 92minutes and of the radioscopy 35.2minutes. Statistically significant changes were demonstrated (p <.05) in PSA, peak urinary flow, QoL (quality of life) questionnaire and the International Index of Erectile Function (IPSS). PSA had reduced by 58% from baseline at 3 months. Similarly, the Qmax had increased significantly by 63% in the third month following embolisation. A significant improvement in the QoL and IPSS tests was achieved, with a reduction of 3.7 points and a mean 13.5 points, respectively, at one year's follow-up. Prostate volume showed a non-statistically significant decrease at follow-up of one year following treatment. A series of minor complications was collected, no case of which required hospital admission. CONCLUSIONS Prostatic embolisation for the treatment of BPH proved an effective and safe technique in patients who were not candidates for surgery.
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Affiliation(s)
- R Monreal
- Unidad de Radiología Intervencionista, Hospital Virgen de la Salud, Complejo Hospitalario Universitario de Toledo, Toledo, España
| | - C Robles
- Servicio Endovascular, Hospital Universitario Virgen Macarena, Sevilla, España
| | - M Sánchez-Casado
- UCI-Bioestadística, Complejo Hospitalario Universitario de Toledo, Toledo, España
| | - J J Ciampi
- Unidad de Radiología Intervencionista, Hospital Virgen de la Salud, Complejo Hospitalario Universitario de Toledo, Toledo, España
| | - M López-Guerrero
- Servicio de Urología, Hospital Virgen de la Salud, Complejo Hospitalario Universitario de Toledo, Toledo, España
| | - R J Ruíz-Salmerón
- Servicio Endovascular, Hospital Universitario Virgen Macarena, Sevilla, España
| | - C Lanciego
- Unidad de Radiología Intervencionista, Hospital Virgen de la Salud, Complejo Hospitalario Universitario de Toledo, Toledo, España.
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Abstract
Background: Transurethral resection of the prostate (TURP) is 'Gold Standard' treatment for moderate-to-severe lower urinary tract symptoms (LUTS) due to benign prostate hyperplasia (BPH) with bladder-outlet obstruction (BOO). However, TURP is associated with a risk of complications, so minimally invasive methods have been developed. Prostate artery embolization (PAE) is a new minimally invasive procedure. This study reports the outcomes of PAE when introduced in a 'real life' clinical setting in a Swedish County hospital. Methods: A prospective, single-center, single-arm study in a consecutive vascular-anatomy 'all comers' population, eligible for TURP or adenomaenukleation, but unsuitable for this, treated with PAE from January 2015 to June 2018. Defined improvement of IPSS/QoL scores, or freedom from urinary catheter if previous urinary catheter-dependent, or clean intermittent catheterization (CIC) were considered as clinically successful treatments. PAE was performed until arterial stasis using the Perfected technique. Most patients were treated during a day-care procedure. Results: Of 37 treated men, bilateral PAEs were achieved in 32 patients, unilateral PAEs in four patients, and bilateral failure in one patient due to difficult vascular anatomy. Clinically successful treatment was achieved in 84%, without serious adverse events. Conclusions: PAE was introduced in Sweden, showing PAE as a novel and good minimally invasive alternative in treatment of symptomatic BPH, possible to perform as a day-care procedure.
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Affiliation(s)
- Hans Lindgren
- a Department of Clinical Sciences, Faculty of Medicine , Lund University , Lund , Sweden.,b Department of Surgery, Section of Interventional Radiology , Helsingborg Hospital , Helsingborg , Sweden
| | - Mats Bläckberg
- a Department of Clinical Sciences, Faculty of Medicine , Lund University , Lund , Sweden.,c Department of Urology , Helsingborg Hospital , Helsingborg , Sweden
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29
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Angiographic Findings during Repeat Prostatic Artery Embolization. J Vasc Interv Radiol 2019; 30:645-651. [DOI: 10.1016/j.jvir.2018.12.734] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 12/27/2018] [Accepted: 12/28/2018] [Indexed: 12/21/2022] Open
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Prostate Artery Embolization for Lower Urinary Tract Symptoms in Men Unfit for Surgery. Diagnostics (Basel) 2019; 9:diagnostics9020046. [PMID: 31027211 PMCID: PMC6628284 DOI: 10.3390/diagnostics9020046] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 04/18/2019] [Accepted: 04/24/2019] [Indexed: 11/17/2022] Open
Abstract
Nearly one in three men develop lower urinary tract symptoms (LUTS) and 10% clinically progress despite medication. Transurethral resection of the prostate (TURP) is the reference standard for symptoms refractory to medical treatment. However, some patients cannot tolerate TURP for medical (e.g., comorbidity) or technical (e.g., large prostate) reasons. This study estimated the safety and effect of prostate artery embolization (PAE) in men unfit for surgery. A prospective, single-centre trial including men with LUTS or urinary retention secondary to benign prostatic hyperplasia (BPH) who were unfit for surgery. The primary objective was to treat urinary retention and LUTS. Outcome measures included International Prostate Symptom Score (IPSS), quality of life (IPSS-QoL), International Index of Erectile Function (IIEF-5), prostate volume (PV), prostate-specific antigen (PSA), peak void flow (Qmax), post-void residual (PVR), and complications. A p-value < 0.05 was considered statistically significant. Eleven consecutive patients with a mean age of 75.2 (SD ± 8.2) underwent PAE. Catheter removal was successful in 60%. IPSS-QoL improved 4.5 points (95% CI: -5.6; -3.4), and PV was reduced by 26.2 cm3 (95% CI: -50.9; -2.3). None of the remaining outcomes changed. No major complications occurred. PAE was effective and safe for LUTS and urinary retention associated with BPH in men unfit for surgery.
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31
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de Assis AM, Moreira AM, Carnevale FC, Marcelino ASZ, de Oliveira Cerri LM, Antunes AA, Srougi M, Cerri GG. Effects of Prostatic Artery Embolization on the Dynamic Component of Benign Prostate Hyperplasia as Assessed by Ultrasound Elastography: A Pilot Series. Cardiovasc Intervent Radiol 2019; 42:1001-1007. [PMID: 30993369 DOI: 10.1007/s00270-019-02220-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 04/08/2019] [Indexed: 12/11/2022]
Abstract
PURPOSE To determine the effects of prostatic artery embolization (PAE) on prostatic elasticity as assessed by Ultrasound Elastography (US-E), as well as to describe the feasibility and role of US-E as a novel tool in both pre- and post-PAE evaluation. MATERIALS AND METHODS This is a prospective, single-center investigation that included eight patients undergoing PAE for treatment of lower urinary tract symptoms (LUTS) attributed to benign prostate hyperplasia (BPH). Baseline and 3-month follow-up evaluations were performed and included prostate-specific antigen (PSA), uroflowmetry, pelvic magnetic resonance imaging and clinical assessment using the International Prostate Symptom Score (IPSS) questionnaire and the IPSS-Quality of life (QoL) item. US-E with measurement of the prostatic Elastic Modulus (EM) was performed before PAE and at 1-month follow-up. RESULTS After PAE, US-E showed a significant reduction of prostatic EM as assessed in kPa (33.14 vs. 47.24, - 29.8%, p = 0.002) and in m/s (3.75 vs. 4.63, - 19.0%, p < 0.001). Also, the transitional/peripheral zone ratio was significantly reduced by 45.36% (0.53 vs. 0.97, p < 0.05). All eight patients presented with significant LUTS improvement after PAE (p < 0.05 for IPSS, QoL, prostate volume, peak urinary flow rate and PSA). CONCLUSIONS Findings described in this study suggest that PAE significantly reduces prostatic EM, leading to a positive effect on BPH dynamic component related to prostatic elasticity. Also, it features US-E as an additional tool for pre- and post-PAE evaluation, describing a novel indication for this technology.
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Affiliation(s)
- André Moreira de Assis
- Interventional Radiology Department, Radiology Institute, University of Sao Paulo Medical School, Dr. Enéas de Carvalho Aguiar Avenue, 255, Cerqueira César, São Paulo, SP, 05403-000, Brazil.
- Interventional Radiology Department, Sírio-Libanês Hospital, Adma Jafet Street, 115 Bela Vista, São Paulo, SP, 01308-050, Brazil.
| | - Airton Mota Moreira
- Interventional Radiology Department, Radiology Institute, University of Sao Paulo Medical School, Dr. Enéas de Carvalho Aguiar Avenue, 255, Cerqueira César, São Paulo, SP, 05403-000, Brazil
- Interventional Radiology Department, Sírio-Libanês Hospital, Adma Jafet Street, 115 Bela Vista, São Paulo, SP, 01308-050, Brazil
| | - Francisco Cesar Carnevale
- Interventional Radiology Department, Radiology Institute, University of Sao Paulo Medical School, Dr. Enéas de Carvalho Aguiar Avenue, 255, Cerqueira César, São Paulo, SP, 05403-000, Brazil
- Interventional Radiology Department, Sírio-Libanês Hospital, Adma Jafet Street, 115 Bela Vista, São Paulo, SP, 01308-050, Brazil
| | | | | | - Alberto Azoubel Antunes
- Urology Department, University of Sao Paulo Medical School, Dr. Enéas de Carvalho Aguiar Avenue, 255, Cerqueira César, São Paulo, SP, 05403-000, Brazil
| | - Miguel Srougi
- Urology Department, University of Sao Paulo Medical School, Dr. Enéas de Carvalho Aguiar Avenue, 255, Cerqueira César, São Paulo, SP, 05403-000, Brazil
| | - Giovanni Guido Cerri
- Radiology Department, Sírio-Libanês Hospital, Adma Jafet Street, 115, Bela Vista, São Paulo, SP, 01308-050, Brazil
- Radiology Institute, University of Sao Paulo Medical School, Dr. Enéas de Carvalho Aguiar Avenue, 255, Cerqueira César, São Paulo, SP, 05403-000, Brazil
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McWilliams JP, Bilhim TA, Carnevale FC, Bhatia S, Isaacson AJ, Bagla S, Sapoval MR, Golzarian J, Salem R, McClure TD, Kava BR, Spies JB, Sabharwal T, McCafferty I, Tam AL. Society of Interventional Radiology Multisociety Consensus Position Statement on Prostatic Artery Embolization for Treatment of Lower Urinary Tract Symptoms Attributed to Benign Prostatic Hyperplasia: From the Society of Interventional Radiology, the Cardiovascular and Interventional Radiological Society of Europe, Société Française de Radiologie, and the British Society of Interventional Radiology: Endorsed by the Asia Pacific Society of Cardiovascular and Interventional Radiology, Canadian Association for Interventional Radiology, Chinese College of Interventionalists, Interventional Radiology Society of Australasia, Japanese Society of Interventional Radiology, and Korean Society of Interventional Radiology. J Vasc Interv Radiol 2019; 30:627-637.e1. [PMID: 30926185 DOI: 10.1016/j.jvir.2019.02.013] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 02/13/2019] [Indexed: 12/14/2022] Open
Affiliation(s)
- Justin P McWilliams
- Department of Radiology, Division of Interventional Radiology, David Geffen School of Medicine at UCLA, Los Angeles, California.
| | - Tiago A Bilhim
- Interventional Radiology Department, St. Louis Hospital, Lisbon, Portugal
| | - Francisco C Carnevale
- Department of Interventional Radiology, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Shivank Bhatia
- Department of Radiology and Division of Vascular Interventional Radiology, University of Miami Miller School of Medicine, Miami, Florida
| | - Ari J Isaacson
- Department of Radiology, University of North Carolina, Chapel Hill, North Carolina
| | - Sandeep Bagla
- Vascular Institute of Virginia, Woodbridge, Virginia
| | - Marc R Sapoval
- Department of Vascular and Oncologic Interventional Radiology, Hôpital Européen Georges Pompidou, Paris, France
| | - Jafar Golzarian
- Department of Radiology, Division of Interventional Radiology and Vascular Imaging, University of Minnesota, Minneapolis, Minnesota
| | - Riad Salem
- Department of Radiology, Northwestern University, Chicago, Illinois
| | - Timothy D McClure
- Department of Urology, Weill Cornell Medicine, Lefrak Center for Robotic Surgery, New York, New York
| | - Bruce R Kava
- Department of Urology, University of Miami Miller School of Medicine, Miami, Florida
| | - James B Spies
- Department of Radiology, Georgetown University Medical Center, Washington, DC
| | - Tarun Sabharwal
- Department of Radiology, Guys and St Thomas' Hospital, London, United Kingdom
| | - Ian McCafferty
- Department of Clinical Radiology, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
| | - Alda L Tam
- Department of Interventional Radiology, MD Anderson Cancer Center, Houston, Texas
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33
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Young S, Golzarian J. Prostate embolization: patient selection, clinical management and results. CVIR Endovasc 2019; 2:7. [PMID: 32027007 PMCID: PMC6966395 DOI: 10.1186/s42155-019-0049-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 01/06/2019] [Indexed: 11/24/2022] Open
Abstract
Background Prostate artery embolization is an emerging technique, that with the continued publication of promising data, is slowly moving from the research to the everyday clinical setting. Main body This paper reviews the patient selection, clinical management and expected results of prostate artery embolization. Patient selection is paramount in delivering the desired results for any procedure. Likewise, the ability to clinically manage patients in the pre-operative and post-operative setting is an important skill to acquire when implementing new techniques. This paper introduces important urologic measurements/tests, patient selection paradigms, and clinical management concepts for interventional radiologists. It also reviews the outcomes patients can expect following prostate artery embolization as well as the complication profile. Conclusion Prostate artery embolization is a promising technique for the treatment of benign prostatic hyperplasia induced lower urinary tract symptoms.
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Affiliation(s)
- Shamar Young
- Department of Radiology, Division of Interventional Radiology, University of Minnesota, 420 Delaware ST SE, Minneapolis, MN, 55455, USA.
| | - Jafar Golzarian
- Department of Radiology, Division of Interventional Radiology, University of Minnesota, 420 Delaware ST SE, Minneapolis, MN, 55455, USA
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34
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Bhatia S, Sinha VK, Harward S, Gomez C, Kava BR, Parekh DJ. Prostate Artery Embolization in Patients with Prostate Volumes of 80 mL or More: A Single-Institution Retrospective Experience of 93 Patients. J Vasc Interv Radiol 2018; 29:1392-1398. [PMID: 30217744 DOI: 10.1016/j.jvir.2018.05.012] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2017] [Revised: 05/14/2018] [Accepted: 05/14/2018] [Indexed: 01/23/2023] Open
Abstract
PURPOSE To evaluate the safety and efficacy of prostate artery embolization (PAE) for the treatment of benign prostatic hyperplasia for prostates ≥ 80 mL. PATIENTS AND METHODS A retrospective review was conducted of 93 patients with prostate volumes (PVs) ≥ 80 mL treated with PAE from April 2014 through October 2017. Mean patient age was 68.5 years (range 52-88) and mean age-adjusted Charlson comorbidity index was 3.2 (range 1-8). Exclusion criteria included history of biopsy-proven prostate cancer or catheter dependency. Clinical and urodynamic outcomes were reviewed at 1, 3, 6, and 12 months. Adverse events were graded according to the Clavien-Dindo classification. RESULTS Mean PV decreased significantly from 141.7 mL to 98.1 mL at 3 months (P < .01) and 82.2 mL at 12 months (P < .01). Significant improvements were seen in 3- and 12-month mean International Prostate Symptom Scores (IPSS) (22.3 vs 7.1 and 7.3, respectively; P < .01 for both), quality of life (QOL) (4.4 vs 1.2 and 1.3; P < .01 for both), and postvoid residual volume (196.7mL vs 92.1 and 61.2 mL; P < .01 and P < .01, respectively). Significant improvement was also seen in 3-month mean maximum urinary flow: 7.7 mL/s vs 12.8 mL/s (P < .01). One grade II complication of stroke occurred; all other complications were self-limited and grade I. CONCLUSIONS PAE achieved a clinically and statistically significant improvement in symptom burden and secondary outcome measures in patients with PVs ≥ 80 mL. PAE may be an alternate treatment for patients for whom conventional surgical options are limited or associated with significant morbidity.
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Affiliation(s)
- Shivank Bhatia
- Department of Vascular and Interventional Radiology, Jackson Memorial Hospital, University of Miami Miller School of Medicine, Miami VA Healthcare, 1150 NW 14th St, Suite 511, Miami, Florida 33136.
| | - Vishal K Sinha
- University of Miami Miller School of Medicine, Miami VA Healthcare, 1150 NW 14th St, Suite 511, Miami, Florida 33136
| | - Sardis Harward
- The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire
| | - Christopher Gomez
- Department of Urology, Jackson Memorial Hospital, University of Miami Miller School of Medicine, Miami VA Healthcare, 1150 NW 14th St, Suite 511, Miami, Florida 33136
| | - Bruce R Kava
- Department of Urology, Jackson Memorial Hospital, University of Miami Miller School of Medicine, Miami VA Healthcare, 1150 NW 14th St, Suite 511, Miami, Florida 33136
| | - Dipen J Parekh
- Department of Urology, Jackson Memorial Hospital, University of Miami Miller School of Medicine, Miami VA Healthcare, 1150 NW 14th St, Suite 511, Miami, Florida 33136
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Brown N, Walker D, McBean R, Pokorny M, Kua B, Gianduzzo T, Dunglison N, Esler R, Yaxley J. Prostate artery Embolisation Assessment of Safety and feasibilitY (P-EASY): a potential alternative to long-term medical therapy for benign prostate hyperplasia. BJU Int 2018; 122 Suppl 5:27-34. [DOI: 10.1111/bju.14504] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Nicholas Brown
- Wesley Medical Imaging; The Wesley Hospital; Auchenflower Queensland Australia
| | - Duncan Walker
- Wesley Medical Imaging; The Wesley Hospital; Auchenflower Queensland Australia
| | - Rhiannon McBean
- Wesley Medical Imaging; The Wesley Hospital; Auchenflower Queensland Australia
| | - Morgan Pokorny
- Department of Urology; The Wesley Hospital; Auchenflower Queensland Australia
| | - Boon Kua
- Department of Urology; The Wesley Hospital; Auchenflower Queensland Australia
| | - Troy Gianduzzo
- Department of Urology; The Wesley Hospital; Auchenflower Queensland Australia
| | - Nigel Dunglison
- Department of Urology; The Wesley Hospital; Auchenflower Queensland Australia
| | - Rachel Esler
- Department of Urology; The Wesley Hospital; Auchenflower Queensland Australia
| | - John Yaxley
- Department of Urology; The Wesley Hospital; Auchenflower Queensland Australia
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Bhatia S, Sinha VK, Abdul-Rahim O, Harward S, Narayanan G. Rare Prostatic Artery Origins and the Importance of Collateral Circulation in Prostate Artery Embolization: A Pictorial Essay. Can Assoc Radiol J 2018; 69:220-229. [DOI: 10.1016/j.carj.2017.11.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Revised: 09/16/2017] [Accepted: 11/07/2017] [Indexed: 11/15/2022] Open
Affiliation(s)
- Shivank Bhatia
- Department of Vascular and Interventional Radiology, University of Miami Miller School of Medicine, Miami, Florida
| | - Vishal K. Sinha
- Miller School of Medicine, University of Miami, Miami, Florida
| | - Osama Abdul-Rahim
- Department of Vascular and Interventional Radiology, University of Miami Miller School of Medicine, Miami, Florida
| | - Sardis Harward
- Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - Govindarajan Narayanan
- Department of Vascular and Interventional Radiology, University of Miami Miller School of Medicine, Miami, Florida
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Magistro G, Chapple CR, Elhilali M, Gilling P, McVary KT, Roehrborn CG, Stief CG, Woo HH, Gratzke C. Emerging Minimally Invasive Treatment Options for Male Lower Urinary Tract Symptoms. Eur Urol 2017; 72:986-997. [DOI: 10.1016/j.eururo.2017.07.005] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Accepted: 07/04/2017] [Indexed: 01/20/2023]
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Nunes RLV, Antunes AA, Constantin DS. Contemporary surgical treatment of benign prostatic hyperplasia. Rev Assoc Med Bras (1992) 2017; 63:711-716. [PMID: 28977110 DOI: 10.1590/1806-9282.63.08.711] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Accepted: 07/21/2017] [Indexed: 11/22/2022] Open
Abstract
Benign prostatic hyperplasia (BPH) is a common condition in adult men and its incidence increases progressively with aging. It has an important impact on the individual's physical and mental health and its natural progression can lead to serious pathological situations. Although the initial treatment is pharmacological, except in specific situations, the tendency of disease progression causes a considerable portion of the patients to require surgical treatment. In this case, there are several options available today in the therapeutic armamentarium. Among the options, established techniques, such as open surgery and endoscopic resection using monopolar energy, still prevail in the choice of surgeons because they are more accessible, both from a socioeconomic standpoint in the vast majority of medical services and in terms of training of medical teams. On the other hand, new techniques and technologies arise sequentially in order to minimize aggression, surgical time, recovery and complications, optimizing results related to the efficacy/safety dyad. Each of these techniques has its own peculiarities regarding availability due to cost, learning curve and scientific consolidation in order to achieve recognition as a cutting-edge method in the medical field. The use of bipolar energy in endoscopic resection of the prostate, laser vaporization and enucleation techniques, and videolaparoscopy are examples of new options that have successfully traced this path. Robot-assisted surgery has gained a lot of space in the last decade, but it still needs to dodge the trade barrier. Other techniques and technologies will need to pass the test of time to be able to conquer their space in this growing market.
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Affiliation(s)
- Ricardo Luís Vita Nunes
- Head of the Benign Prostatic Hyperplasia Department, Sociedade Brasileira de Urologia (SBU). Assistant Physician, Division of Urology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP). Head of the Urology Clinic, Hospital Militar de Área de São Paulo - Exército Brasileiro, São Paulo, SP, Brazil
| | - Alberto Azoubel Antunes
- Associate Professor, Division of Urology, Head of the Urology Graduate Program, and Coordinator of the Prostate Sector, Division of Urology, FMUSP, São Paulo, SP, Brazil
| | - Davi Souza Constantin
- Preceptor of Urology, Centro de Referência do Homem do Hospital de Transplantes Euryclides de Jesus Zerbini. MD, Urologist, Hospital Militar de Área de São Paulo - Exército Brasileiro, São Paulo, SP, Brazil
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39
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Spontaneous Bladder Stone Voiding after Prostatic Artery Embolization. J Vasc Interv Radiol 2017; 28:1611-1613. [DOI: 10.1016/j.jvir.2017.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Revised: 06/07/2017] [Accepted: 06/08/2017] [Indexed: 11/21/2022] Open
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Kosilov K, Loparev S, Kuzina I, Kosilova L, Ivanovskaya M, Prokofyeva A. Health-related quality of life's dependence on socio-economic status and demographic characteristics among men with benign prostatic hyperplasia. Andrologia 2017; 50. [DOI: 10.1111/and.12892] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/25/2017] [Indexed: 12/30/2022] Open
Affiliation(s)
- K. Kosilov
- Department of Social and Psychological Sciences; School of Humanities; Far Eastern Federal University; Vladivostok Russian Federation
- Department of Public Health; Pacific State Medical University; Vladivostok Russian Federation
| | - S. Loparev
- Department of Urology; City Polyclinic no 3; Vladivostok Russian Federation
| | - I. Kuzina
- Department of Social and Psychological Sciences; School of Humanities; Far Eastern Federal University; Vladivostok Russian Federation
| | - L. Kosilova
- Department of Functional Methods of Diagnostic; Medical Association no 2 of Vladivostok-city; Vladivostok Russian Federation
| | - M. Ivanovskaya
- Department of Law; Far Eastern Fisheries University; Vladivostok Russian Federation
| | - A. Prokofyeva
- Department of Social and Psychological Sciences; School of Humanities; Far Eastern Federal University; Vladivostok Russian Federation
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41
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Favorable Outcome of Conservative Management of Extensive Bladder Ischemia Complicating Prostatic Artery Embolization. Cardiovasc Intervent Radiol 2017; 41:191-196. [PMID: 28828518 DOI: 10.1007/s00270-017-1774-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Accepted: 08/17/2017] [Indexed: 10/19/2022]
Abstract
This is a report of a case of bladder ischemia which complicated bilateral prostatic artery embolization in an 80-year-old man with benign prostate hyperplasia and indwelling bladder catheter. Reflux of 100 μm microspheres into superior vesical arteries was the most likely cause. An unenhanced computed tomography (CT) scan performed immediately post-embolization showed retention of contrast in the left anterolateral bladder wall. Five days later, CT showed gas collections and dehiscence of the bladder wall at the same site, involving an area of 47 × 42 mm. Treatment included prolonged (6 weeks) bladder catheterization and antibiotics. Partial resolution of the CT findings and 43% reduction in the prostatic volume were noted after that period; no leakage was detected on ascending cystogram, and the patient was capable of spontaneous micturition.
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42
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Comparison of Nonspherical Polyvinyl Alcohol Particles and Microspheres for Prostatic Arterial Embolization in Patients with Benign Prostatic Hyperplasia. BIOMED RESEARCH INTERNATIONAL 2017; 2017:8732351. [PMID: 28717651 PMCID: PMC5498973 DOI: 10.1155/2017/8732351] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Revised: 04/09/2017] [Accepted: 05/28/2017] [Indexed: 12/13/2022]
Abstract
Purpose To report early results following prostatic artery embolization (PAE) and compare outcomes between nonspherical polyvinyl alcohol (PVA) particles and microspheres to treat lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH). Methods PAE was performed in nine patients (mean age: 78.1 years) with symptomatic BPH. Embolization was performed using nonspherical PVA particles (250–355 μm) in four patients and microspheres (300–500 μm) in five patients. Results PAE was technically successful in all nine patients (100%). During a mean follow-up of 10.1 months, improvements in mean International Prostate Symptom Score (IPSS), Quality of Life (QoL), prostatic volume (total volume and transition zone), and peak urinary flow (Qmax) were 9.8 points, 2.3 points, 28.1 mL, 17.8 mL, and 4.5 mL/s, respectively. Clinical success was obtained in seven of nine patients (78%). Patients in the microsphere group showed greater improvement in IPSS, QoL, prostatic volume, and Qmax compared to patients in the nonspherical PVA particle group. However, significant difference was noted only in the prostatic volume. Conclusion PAE is a feasible, effective, and safe treatment option for BPH with LUTS. Use of microspheres showed greater prostatic volume reduction compared to nonspherical PVA particles.
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Carnevale FC, Soares GR, de Assis AM, Moreira AM, Harward SH, Cerri GG. Anatomical Variants in Prostate Artery Embolization: A Pictorial Essay. Cardiovasc Intervent Radiol 2017; 40:1321-1337. [PMID: 28508252 DOI: 10.1007/s00270-017-1687-0] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2017] [Accepted: 05/03/2017] [Indexed: 11/26/2022]
Abstract
Prostate artery embolization (PAE) has emerged as a new treatment option for patients with symptomatic benign prostatic hyperplasia. The main challenges related to this procedure are navigating arteries with atherosclerosis and anatomical variations, and the potential risk of non-target embolization to pelvic structures due to the presence of collateral shunts and reflux of microparticles. Knowledge of classical vascular anatomy and the most common variations is essential for safe embolization, good clinical practice, and optimal outcomes. The aim of this pictorial essay is to illustrate the pelvic vascular anatomy relevant to PAE in order to provide a practical guide that includes the most common anatomical variants as well as to discuss the technical details related to each.
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Affiliation(s)
- Francisco Cesar Carnevale
- Department of Radiology, University of Sao Paulo, Av. Dr. Enéas de Carvalho Aguiar, 255, Sao Paulo, SP, 05403-001, Brazil.
| | - Guilherme Rebello Soares
- Department of Radiology, University of Sao Paulo, Av. Dr. Enéas de Carvalho Aguiar, 255, Sao Paulo, SP, 05403-001, Brazil
| | - Andre Moreira de Assis
- Department of Radiology, University of Sao Paulo, Av. Dr. Enéas de Carvalho Aguiar, 255, Sao Paulo, SP, 05403-001, Brazil
| | - Airton Mota Moreira
- Department of Radiology, University of Sao Paulo, Av. Dr. Enéas de Carvalho Aguiar, 255, Sao Paulo, SP, 05403-001, Brazil
| | | | - Giovanni Guido Cerri
- Department of Radiology, University of Sao Paulo, Av. Dr. Enéas de Carvalho Aguiar, 255, Sao Paulo, SP, 05403-001, Brazil
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Rampoldi A, Barbosa F, Secco S, Migliorisi C, Galfano A, Prestini G, Harward SH, Di Trapani D, Brambillasca PM, Ruggero V, Solcia M, Carnevale FC, Bocciardi AM. Prostatic Artery Embolization as an Alternative to Indwelling Bladder Catheterization to Manage Benign Prostatic Hyperplasia in Poor Surgical Candidates. Cardiovasc Intervent Radiol 2017; 40:530-536. [PMID: 28130568 DOI: 10.1007/s00270-017-1582-8] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Accepted: 01/17/2017] [Indexed: 01/21/2023]
Abstract
PURPOSE To prospectively assess discontinuation of indwelling bladder catheterization (IBC) and relief of lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH) following prostate artery embolization (PAE) in poor surgical candidates. METHODS Patients ineligible for surgical intervention were offered PAE after at least 1 month of IBC for management of urinary retention secondary to BPH; exclusion criteria for PAE included eligibility for surgery, active bladder cancer or known prostate cancer. Embolization technical and clinical success were defined as bilateral prostate embolization and removal of IBC, respectively. Patients were followed for at least 6 months and evaluated for International Prostate Symptom Score, quality of life, prostate size and uroflowmetric parameters. RESULTS A total of 43 patients were enrolled; bilateral embolization was performed in 33 (76.7%), unilateral embolization was performed in 8 (18.6%), and two patients could not be embolized due to tortuous and atherosclerotic pelvic vasculature (4.7%). Among the patients who were embolized, mean prostate size decreased from 75.6 ± 33.2 to 63.0 ± 23.2 g (sign rank p = 0.0001, mean reduction of 19.6 ± 17.3%), and IBC removal was achieved in 33 patients (80.5%). Clavien II complications were reported in nine patients (21.9%) and included urinary tract infection (three patients, 7.3%) and recurrent acute urinary retention (six patients, 14.6%). Nine patients (22.0%) experienced post-embolization syndrome. CONCLUSIONS PAE is a safe and feasible for the relief of LUTS and IBC in highly comorbid patients without surgical treatment options.
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Affiliation(s)
- Antonio Rampoldi
- Department of Interventional Radiology, Ospedale Niguarda Ca' Granda, Piazza Ospedale Maggiore, 3, 20100, Milan, Italy
| | - Fabiane Barbosa
- Department of Interventional Radiology, Ospedale Niguarda Ca' Granda, Piazza Ospedale Maggiore, 3, 20100, Milan, Italy.
| | - Silvia Secco
- Department of Urology, Ospedale Niguarda Ca' Granda, Piazza Ospedale Maggiore, 3, 20100, Milan, Italy
| | - Carmelo Migliorisi
- Department of Interventional Radiology, Ospedale Niguarda Ca' Granda, Piazza Ospedale Maggiore, 3, 20100, Milan, Italy
| | - Antonio Galfano
- Department of Urology, Ospedale Niguarda Ca' Granda, Piazza Ospedale Maggiore, 3, 20100, Milan, Italy
| | - Giovanni Prestini
- Department of Urology, Ospedale Niguarda Ca' Granda, Piazza Ospedale Maggiore, 3, 20100, Milan, Italy
| | - Sardis Honoria Harward
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth-Hitchcock Medical Center, 1 Medical Center Drive, Lebanon, NH, 03756, USA
| | - Dario Di Trapani
- Department of Urology, Ospedale Niguarda Ca' Granda, Piazza Ospedale Maggiore, 3, 20100, Milan, Italy
| | - Pietro Maria Brambillasca
- Department of Interventional Radiology, Ospedale Niguarda Ca' Granda, Piazza Ospedale Maggiore, 3, 20100, Milan, Italy
| | - Vercelli Ruggero
- Department of Interventional Radiology, Ospedale Niguarda Ca' Granda, Piazza Ospedale Maggiore, 3, 20100, Milan, Italy
| | - Marco Solcia
- Department of Interventional Radiology, Ospedale Niguarda Ca' Granda, Piazza Ospedale Maggiore, 3, 20100, Milan, Italy
| | - Francisco Cesar Carnevale
- Department of Interventional Radiology, University of Sao Paulo Medical School, Av. Dr. Enéas de Carvalho Aguiar, 255, Sao Paulo, SP, 05403-001, Brazil
| | - Aldo Massimo Bocciardi
- Department of Urology, Ospedale Niguarda Ca' Granda, Piazza Ospedale Maggiore, 3, 20100, Milan, Italy
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45
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Recurrence of Lower Urinary Tract Symptoms Following Prostate Artery Embolization for Benign Hyperplasia: Single Center Experience Comparing Two Techniques. Cardiovasc Intervent Radiol 2017; 40:366-374. [DOI: 10.1007/s00270-017-1569-5] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Accepted: 01/02/2017] [Indexed: 11/25/2022]
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46
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Mirakhur A, McWilliams JP. Prostate Artery Embolization for Benign Prostatic Hyperplasia: Current Status. Can Assoc Radiol J 2016; 68:84-89. [PMID: 27887933 DOI: 10.1016/j.carj.2016.06.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2016] [Revised: 05/04/2016] [Accepted: 06/18/2016] [Indexed: 11/17/2022] Open
Abstract
Prostate artery embolization has garnered much attention as a promising treatment for lower urinary tract symptoms secondary to benign prostatic hyperplasia. We aim to provide an up-to-date review of this minimally invasive technique, including discussion of potential benefits and technical challenges. Current evidence suggests it is a safe and effective option for patients with medication-refractory urinary obstructive symptoms who are poor surgical candidates or refuse surgical therapy. Larger, randomized studies with long-term follow-up data are needed for this technique to be formally established in the treatment paradigm for benign prostatic hyperplasia.
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Affiliation(s)
- Anirudh Mirakhur
- Division of Interventional Radiology, Department of Radiological Sciences, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, USA
| | - Justin P McWilliams
- Division of Interventional Radiology, Department of Radiological Sciences, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, USA.
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47
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Feng S, Tian Y, Liu W, Li Z, Deng T, Li H, Wang K. Prostatic Arterial Embolization Treating Moderate-to-Severe Lower Urinary Tract Symptoms Related to Benign Prostate Hyperplasia: A Meta-Analysis. Cardiovasc Intervent Radiol 2016; 40:22-32. [DOI: 10.1007/s00270-016-1516-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Accepted: 11/15/2016] [Indexed: 12/12/2022]
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48
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Prostate Zonal Volumetry as a Predictor of Clinical Outcomes for Prostate Artery Embolization. Cardiovasc Intervent Radiol 2016; 40:245-251. [DOI: 10.1007/s00270-016-1518-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Accepted: 11/15/2016] [Indexed: 10/20/2022]
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49
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Uflacker A, Haskal ZJ, Bilhim T, Patrie J, Huber T, Pisco JM. Meta-Analysis of Prostatic Artery Embolization for Benign Prostatic Hyperplasia. J Vasc Interv Radiol 2016; 27:1686-1697.e8. [DOI: 10.1016/j.jvir.2016.08.004] [Citation(s) in RCA: 85] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2016] [Revised: 08/02/2016] [Accepted: 08/05/2016] [Indexed: 10/20/2022] Open
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50
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Yu H, Isaacson AJ, Burke CT. Review of Current Literature for Prostatic Artery Embolization. Semin Intervent Radiol 2016; 33:231-5. [PMID: 27582611 DOI: 10.1055/s-0036-1586141] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Prostatic artery embolization (PAE) is an emerging, novel interventional technique in the management of patients with lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH). BPH is a common clinical condition in middle-aged and elderly men resulting in LUTS, including nocturia, urinary frequency, urgency, decreased urinary flow rates, hesitancy, and incomplete bladder emptying. Traditionally, LUTSs have been managed by medical or surgical therapies. Since the initial incidental discovery that selective PAE performed for uncontrolled bleeding secondary to BPH resulted in improved LUTS, the technique has continually evolved with a growing body of evidence supporting its safety and efficacy. However, despite the available data, PAE has yet to be established as a standard-of-care treatment option for patients with LUTS/BPH. In this article, the authors review the history and current state of PAE, including published data from case reports, animal studies, retrospective/prospective cohort studies, and prospective randomized controlled trials.
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Affiliation(s)
- Hyeon Yu
- Division of Vascular and Interventional Radiology, Department of Radiology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Ari J Isaacson
- Division of Vascular and Interventional Radiology, Department of Radiology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Charles T Burke
- Division of Vascular and Interventional Radiology, Department of Radiology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
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