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Maclean D, Vigneswaran G, Maher B, Hadi M, Harding J, Harris M, Bryant T, Hacking N, Modi S. The Effect of Protective Coil Embolization of Penile Anastomoses during Prostatic Artery Embolization on Erectile Function: A Propensity-Matched Analysis. J Vasc Interv Radiol 2023; 34:218-224.e1. [PMID: 36283591 DOI: 10.1016/j.jvir.2022.10.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 09/15/2022] [Accepted: 10/13/2022] [Indexed: 11/07/2022] Open
Abstract
PURPOSE To explore whether coil embolization of penile collateral arteries to prevent nontarget embolization during prostatic artery embolization (PAE) negatively affects erectile function. MATERIALS AND METHODS Retrospective analysis was performed on a prospectively maintained multicenter PAE database on all patients with benign prostatic hyperplasia (January 2014 to July 2016). International Index of Erectile Function (IIEF-5) scores were collected at baseline and within 12 months after the procedure. A logistic regression and nearest neighbor propensity-matched analysis (matched for age, baseline IIEF-5 scores, and use of 5α-reductase inhibitors) and paired t test were used to evaluate for differential impact on IIEF-5 scores between the group of patients who underwent (unilateral) penile collateral coil embolization and a matched control group of patients who did not. RESULTS Of a total of 216 patients, 26 underwent coil protection of an accessory pudendal vessel/penile collateral. After exclusions, 22 propensity-matched pairs were identified. The mean IIEF-5 score at baseline for the coil-embolized group was 14.8 ± 8.3 (out of a possible score of 30) and that for the matched control group was 14.0 ± 7.8. At the 12-month follow-up after the procedure, the mean follow-up IIEF-5 score was 15.5 ± 8.0 for the coil-embolized group and 14.2 ± 8.2 for the matched control group. The change in IIEF-5 scores after PAE was not significantly different between the 2 groups (0.66 ± 3.8 vs 0.20 ± 2.0; P = .64; 95% CI, -1.53 to 2.44). CONCLUSIONS When penile collateral arteries were identified, protective coil embolization of penile collateral/accessory pudendal vessels during PAE was unlikely to affect erectile function negatively.
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Affiliation(s)
- Drew Maclean
- Department of Interventional Radiology, University Hospital Southampton, Southampton, United Kingdom.
| | - Ganesh Vigneswaran
- Department of Interventional Radiology, University Hospital Southampton, Southampton, United Kingdom; Cancer Sciences, University of Southampton, Southampton General Hospital, Southampton, United Kingdom
| | - Benjamin Maher
- Department of Interventional Radiology, University Hospital Southampton, Southampton, United Kingdom
| | - Mohammed Hadi
- Department of Interventional Radiology, University Hospital Southampton, Southampton, United Kingdom
| | - James Harding
- Department of Interventional Radiology, University Hospitals Coventry and Warwickshire, Coventry, United Kingdom
| | - Mark Harris
- Department of Urology, University Hospital Southampton, Southampton, United Kingdom
| | - Timothy Bryant
- Department of Interventional Radiology, University Hospital Southampton, Southampton, United Kingdom
| | - Nigel Hacking
- Department of Interventional Radiology, University Hospital Southampton, Southampton, United Kingdom
| | - Sachin Modi
- Department of Interventional Radiology, University Hospital Southampton, Southampton, United Kingdom
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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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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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Picel AC, Hsieh TC, Shapiro RM, Vezeridis AM, Isaacson AJ. Prostatic Artery Embolization for Benign Prostatic Hyperplasia: Patient Evaluation, Anatomy, and Technique for Successful Treatment. Radiographics 2019; 39:1526-1548. [PMID: 31348735 DOI: 10.1148/rg.2019180195] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Symptomatic benign prostatic hyperplasia is a common condition in the aging population that results in bothersome lower urinary tract symptoms and decreased quality of life. Patients often are treated with medication and offered surgery for persistent symptoms. Transurethral resection of the prostate is considered the traditional standard of care, but several minimally invasive surgical treatments also are offered. Prostatic artery embolization (PAE) is emerging as an effective treatment option with few reported adverse effects, minimal blood loss, and infrequent overnight hospitalization. The procedure is offered to patients with moderate to severe lower urinary tract symptoms and depressed urinary flow due to bladder outlet obstruction. Proper patient selection and meticulous embolization are critical to optimize results. To perform PAE safely and avoid nontarget embolization, interventional radiologists must have a detailed understanding of the pelvic arterial anatomy. Although the prostatic arteries often arise from the internal pudendal arteries, several anatomic variants and pelvic anastomoses are encountered. Prospective cohort studies, small randomized controlled trials, and meta-analyses have shown improved symptoms after treatment, with serious adverse effects occurring rarely. This article reviews the basic principles of PAE that must be understood to develop a thriving PAE practice. These principles include patient evaluation, review of surgical therapies, details of pelvic arterial anatomy, basic principles of embolization, and an overview of published results. Online supplemental material is available for this article. ©RSNA, 2019.
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Affiliation(s)
- Andrew C Picel
- From the Departments of Radiology (A.C.P., A.M.V.) and Urology (T.C.H., R.M.S.), University of California San Diego, San Diego, Calif, and Department of Radiology, University of North Carolina School of Medicine, Chapel Hill, NC (A.J.I.)
| | - Tung-Chin Hsieh
- From the Departments of Radiology (A.C.P., A.M.V.) and Urology (T.C.H., R.M.S.), University of California San Diego, San Diego, Calif, and Department of Radiology, University of North Carolina School of Medicine, Chapel Hill, NC (A.J.I.)
| | - Rachel M Shapiro
- From the Departments of Radiology (A.C.P., A.M.V.) and Urology (T.C.H., R.M.S.), University of California San Diego, San Diego, Calif, and Department of Radiology, University of North Carolina School of Medicine, Chapel Hill, NC (A.J.I.)
| | - Alex M Vezeridis
- From the Departments of Radiology (A.C.P., A.M.V.) and Urology (T.C.H., R.M.S.), University of California San Diego, San Diego, Calif, and Department of Radiology, University of North Carolina School of Medicine, Chapel Hill, NC (A.J.I.)
| | - Ari J Isaacson
- From the Departments of Radiology (A.C.P., A.M.V.) and Urology (T.C.H., R.M.S.), University of California San Diego, San Diego, Calif, and Department of Radiology, University of North Carolina School of Medicine, Chapel Hill, NC (A.J.I.)
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Yao C, Li H, Zhang W. Triptolide inhibits benign prostatic epithelium viability and migration and induces apoptosis via upregulation of microRNA-218. Int J Immunopathol Pharmacol 2019; 32:2058738418812349. [PMID: 30453799 PMCID: PMC6247479 DOI: 10.1177/2058738418812349] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Benign prostatic hypertrophy (BPH) has become a troublesome disease for elder
men. Triptolide (TPL) has been reported to be a potential anticancer agent.
However, the potential effects of TPL on BPH have not been shown out. BPH-1
cells were treated with different concentrations of TPL and/or transfected with
microRNA-218 (miR-218) inhibitor, pc-survivin, sh-survivin, or their
corresponding controls (NC). Thereafter, cell viability was determined by CCK-8
assay. Cell migration was accessed by modified two-chamber migration assay. Cell
apoptosis was checked by propidium iodide (PI) and fluorescein isothiocyanate
(FITC)-conjugated Annexin V staining. In addition, messenger RNA (mRNA) and
protein levels were detected using quantitative real-time polymerase chain
reaction (qRT-PCR) and western blot analysis, respectively. BPH-1 cell viability
and migration were significantly decreased, while cell apoptosis and expression
of miR-218 were statistically enhanced by TPL (P < 0.05 or
P < 0.01). However, downregulation of miR-218 increased
cell viability and migration, while decreased cell apoptosis compared with the
negative control group (P < 0.05 or
P < 0.01). Furthermore, the expression of cell cycle–related
proteins and cell apoptosis–related proteins were also led to the opposite
results with NC. In addition, we found that miR-218 negatively regulated the
expression of survivin (P < 0.01) and suppression of
survivin significantly enhanced cell apoptosis (P < 0.01).
Moreover, the results demonstrated that TPL could inactivate mammalian target of
rapamycin (mTOR) pathway, while inhibition of miR-218 alleviated the effects.
TPL inhibits viability and migration of BPH-1 cells and induces cell apoptosis
and also inactivates mTOR signal pathway via upregulation of miR-218. This study
provides evidence for the further studies representing triptolide as a potential
agent in the treatment of human BPH.
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Affiliation(s)
- Changlei Yao
- 1 Department of Urinary Surgery, People's Hospital of Rizhao, Rizhao, China
| | - Hongfa Li
- 1 Department of Urinary Surgery, People's Hospital of Rizhao, Rizhao, China
| | - Weitao Zhang
- 2 Department of Urinary Surgery, Affiliated Hospital of Taishan Medical University, Taian, China
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Zhang JL, Yuan K, Wang MQ, Yan JY, Wang Y, Zhang GD. Seminal vesicle abnormalities following prostatic artery embolization for the treatment of benign prostatic hyperplasia. BMC Urol 2018; 18:92. [PMID: 30355294 PMCID: PMC6201578 DOI: 10.1186/s12894-018-0407-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Accepted: 10/17/2018] [Indexed: 11/10/2022] Open
Abstract
Background Prostatic artery embolization (PAE) has been proved effective in the treatment of lower urinary tracts (LUTS) secondary to benign prostatic hyperplasia (BPH) with low complications, and most of the them are due to non-target embolization of adjacent organs, such as bladder, rectum, seminal vesicles and penis. Aim of this study was to present seminal vesicle (SV) abnormalities following prostatic artery embolization (PAE) for the treatment of symptomatic benign prostatic hyperplasia. Methods We reviewed 139 BPH patients who received PAE during the period of February 2009 and January 2015 at a single institution, highlighting seminal vesicle abnormalities and their clinical relevance after PAE. PAE was performed using 90~ 180-μm (mean 100-μm) polyvinyl alcohol foam particles. Results Nine of 139 patients with SV abnormalities (6.5%) were identified by magnetic resonance imaging (MRI), including subacute haemorrhage in 3 patients and ischaemia in 6 patients. Using cone-beam computed tomography (CB-CT), the seminal vesicle arteries were identified 8 of the 9 patients. All 9 patients complained of a few episodes of mild haematospermia during the 1–4 weeks after PAE; the haematospermia disappeared spontaneously without any treatment. Conclusion SV haemorrhage and ischaemia may occur after PAE, and these patients may present with transient and self-limited haematospermia.
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Affiliation(s)
- Jin Long Zhang
- School of Medicine, Nan Kai University, 94 Wei-jin Rd, Tianjin, 300071, People's Republic of China.,Department of Interventional Radiology, Chinese PLA General Hospital, 28 Fu-xing Rd, Beijing, 100853, People's Republic of China
| | - Kai Yuan
- Department of Interventional Radiology, Chinese PLA General Hospital, 28 Fu-xing Rd, Beijing, 100853, People's Republic of China
| | - Mao Qiang Wang
- School of Medicine, Nan Kai University, 94 Wei-jin Rd, Tianjin, 300071, People's Republic of China. .,Department of Interventional Radiology, Chinese PLA General Hospital, 28 Fu-xing Rd, Beijing, 100853, People's Republic of China.
| | - Jie Yu Yan
- Department of Interventional Radiology, Chinese PLA General Hospital, 28 Fu-xing Rd, Beijing, 100853, People's Republic of China
| | - Yan Wang
- Department of Interventional Radiology, Chinese PLA General Hospital, 28 Fu-xing Rd, Beijing, 100853, People's Republic of China
| | - Guo Dong Zhang
- Department of Interventional Radiology, Chinese PLA General Hospital, 28 Fu-xing Rd, Beijing, 100853, People's Republic of China
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Wang MQ, Zhang JL, Xin HN, Yuan K, Yan J, Wang Y, Zhang GD, Fu JX. Comparison of Clinical Outcomes of Prostatic Artery Embolization with 50-μm Plus 100-μm Polyvinyl Alcohol (PVA) Particles versus 100-μm PVA Particles Alone: A Prospective Randomized Trial. J Vasc Interv Radiol 2018; 29:1694-1702. [PMID: 30297313 DOI: 10.1016/j.jvir.2018.06.019] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 06/24/2018] [Accepted: 06/26/2018] [Indexed: 11/30/2022] Open
Abstract
PURPOSE To evaluate the safety and efficacy of prostatic artery embolization (PAE) using the combination of 50-μm and 100-μm polyvinyl alcohol (PVA) particles versus 100-μm PVA particles alone in the treatment of patients with symptomatic benign prostatic hyperplasia (BPH). MATERIALS AND METHODS Over a 5-year period, 120 patients treated with PAE for lower urinary tract symptoms (LUTS) secondary to BPH were randomized to undergo embolization with 50-μm plus 100-μm PVA particles (group A) or 100-μm PVA particles alone (group B). Mean follow-up time was 34 months (range, 12-57 mo). There were no differences between groups regarding baseline data. Primary outcome measurements included change in International Prostate Symptom Score (IPSS) and incidence of adverse events. Secondary outcome measurements included procedure-associated pain, prostate ischemia measured on magnetic resonance (MR) imaging 1 week after PAE, and changes over time in quality of life (QOL) questionnaire, peak urinary flow rate (Qmax), postvoid residual (PVR) volume, prostate volume (PV), prostate-specific antigen (PSA) level, and International Index of Erectile Function (IIEF) were evaluated. Recurrence of LUTS following PAE was defined as relief of LUTS temporally but increased IPSS ≥ 8 or QOL score ≥ 3 or decrease in Qmax to < 7 mL/s. RESULTS Mean follow-up periods were 35 months ± 22 in group A and 33 months ± 25 in group B (P = .629). No differences between groups regarding procedural details, pain scores, or adverse events were noted (P > .05). At 24 month of follow-up, patients in group A had a greater decrease in mean IPSS (18.7 ± 12.5 vs 14.8 ± 13.5), QOL score (3.7 ± 1.5 vs 2.4 ± 1.8), Qmax (10.5 mL ± 9.5 vs 6.8 mL ± 5.0), PVR (92.0 mL ± 75.0 vs 60.0 mL ± 55.0), and PV (37.0 mL ± 19.5 vs 25.5 mL ± 15.0) compared with patients in group B (P < .05 for all). Mean ratios of prostate ischemic volume at 1 week after PAE were 70% ± 20 in group A and 41% ± 25 in group B (P = .021); mean PSA levels at 24 hour after PAE were 92.5 ng/mL ± 55.0 in group A and 77.5 ng/mL ± 45.0 in group B (P = .031); LUTS recurrence rates were 3.6% in group A and 14.6% in group B (P = .024). The mean IIEF-5 was not significantly different from baseline in either group. CONCLUSIONS PAE with 50-μm plus 100-μm PVA particles resulted in greater improvement in clinical and imaging outcomes and no significant differences in adverse events compared with 100-μm PVA particles alone.
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Affiliation(s)
- Mao Qiang Wang
- Department of Interventional Radiology, Chinese PLA General Hospital, Beijing 100853, P.R. China.
| | - Jin Long Zhang
- Department of Interventional Radiology, Chinese PLA General Hospital, Beijing 100853, P.R. China
| | - Hai Nan Xin
- Department of Interventional Radiology, Chinese PLA General Hospital, Beijing 100853, P.R. China
| | - Kai Yuan
- Department of Interventional Radiology, Chinese PLA General Hospital, Beijing 100853, P.R. China
| | - Jieyu Yan
- Department of Interventional Radiology, Chinese PLA General Hospital, Beijing 100853, P.R. China
| | - Yan Wang
- Department of Interventional Radiology, Chinese PLA General Hospital, Beijing 100853, P.R. China
| | - Guo Dong Zhang
- Department of Interventional Radiology, Chinese PLA General Hospital, Beijing 100853, P.R. China
| | - Jin Xin Fu
- Department of Interventional Radiology, Chinese PLA General Hospital, Beijing 100853, P.R. China
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Abstract
CLINICAL/METHODICAL ISSUE In the treatment of the benign prostatic hyperplasia (BPH) medical and surgical therapies have been established. STANDARD RADIOLOGICAL METHODS Prostate artery embolization (PAE) is an innovative endovascular technique that might close the gap between both these procedures. PERFORMANCE The PAE procedure is safe and has a low incidence of side effects. The efficacy of PAE has been proven for medium sized and large sized glands as well as for intravesical protrusions. ACHIEVEMENTS The complex mechanism of PAE carries the potential to cure lower urinary tract symptoms as well as to retard the progression of the hyperplasia. PRACTICAL RECOMMENDATIONS Data concerning the long-term efficacy are missing at present.
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Affiliation(s)
- A Kovács
- Klinik für diagnostische und interventionelle Radiologie und Neuroradiologie, MediClin Robert Janker Klinik, Villenstraße 8, 53129, Bonn, Deutschland.
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Factors Predicting a Good Symptomatic Outcome After Prostate Artery Embolisation (PAE). Cardiovasc Intervent Radiol 2018; 41:1152-1159. [PMID: 29484467 DOI: 10.1007/s00270-018-1912-5] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Accepted: 02/17/2018] [Indexed: 02/04/2023]
Abstract
INTRODUCTION As prostate artery embolisation (PAE) becomes an established treatment for benign prostatic obstruction, factors predicting good symptomatic outcome remain unclear. Pre-embolisation prostate size as a predictor is controversial with a handful of papers coming to conflicting conclusions. We aimed to investigate if an association existed in our patient cohort between prostate size and clinical benefit, in addition to evaluating percentage volume reduction as a predictor of symptomatic outcome following PAE. MATERIALS OR METHODS Prospective follow-up of 86 PAE patients at a single institution between June 2012 and January 2016 was conducted (mean age 64.9 years, range 54-80 years). Multiple linear regression analysis was performed to assess strength of association between clinical improvement (change in IPSS) and other variables, of any statistical correlation, through Pearson's bivariate analysis. RESULTS No major procedural complications were identified and clinical success was achieved in 72.1% (n = 62) at 12 months. Initial prostate size and percentage reduction were found to have a significant association with clinical improvement. Multiple linear regression analysis (r2 = 0.48) demonstrated that percentage volume reduction at 3 months (r = 0.68, p < 0.001) had the strongest correlation with good symptomatic improvement at 12 months after adjusting for confounding factors. CONCLUSION Both the initial prostate size and percentage volume reduction at 3 months predict good symptomatic outcome at 12 months. These findings therefore aid patient selection and counselling to achieve optimal outcomes for men undergoing prostate artery embolisation.
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Sun F, Báez-Díaz C, Sánchez-Margallo FM. Canine prostate models in preclinical studies of minimally invasive interventions: part II, benign prostatic hyperplasia models. Transl Androl Urol 2017; 6:547-555. [PMID: 28725598 PMCID: PMC5503960 DOI: 10.21037/tau.2017.03.62] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Canine prostate is widely used as animal model in the preclinical evaluation of emerging therapeutic interventions. Spontaneous benign prostatic hyperplasia (BPH) is common in adult intact male dogs with two distinct pathological types: glandular and complex form of prostatic hyperplasia. The complex form of prostatic hyperplasia, usually occurring in older dogs, represents an ideal model because of its unique pathologic feature, including not only glandular hyperplasia but also an increase in prostate stromal components. The limited commercial availability of adult dogs with spontaneous BPH motivates experimentally induced BPH in young dogs. Hormone-induced canine BPH model has been well established with various hormonal treatment regimens and administration approaches. The goal of this review is to provide the veterinary background in spontaneous BPH in dogs, summarize the techniques in hormonal induction of canine BPH, and highlight the pathological and clinical limitations of the canine models that may lead to distinct therapeutic responses compared to clinical trials in humans.
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Affiliation(s)
- Fei Sun
- Jesus Uson Minimally Invasive Surgery Centre, Cáceres, Spain
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Little MW, Boardman P, Macdonald AC, Taylor N, Macpherson R, Crew J, Tapping CR. Adenomatous-Dominant Benign Prostatic Hyperplasia (AdBPH) as a Predictor for Clinical Success Following Prostate Artery Embolization: An Age-Matched Case-Control Study. Cardiovasc Intervent Radiol 2017; 40:682-689. [PMID: 28194505 DOI: 10.1007/s00270-017-1602-8] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Accepted: 02/02/2017] [Indexed: 10/20/2022]
Abstract
PURPOSE To investigate the clinical impact of performing prostate artery embolization (PAE) on patients with adenomatous-dominant benign prostatic hyperplasia (AdBPH). MATERIALS AND METHODS Twelve patients from the ongoing proSTatic aRtery EmbolizAtion for the treatMent of benign prostatic hyperplasia (STREAM) trial were identified as having AdBPH; defined as two or more adenomas within the central gland of ≥1 cm diameter on multi-parametric MRI (MP-MRI). These patients were age-matched with patients from the STREAM cohort, without AdBPH. Patients were followed up with repeat MP-MRI at 3 months and 1 year. International prostate symptom score (IPSS), international index for erectile function (IIEF), and quality of life assessment from the IPSS and EQ-5D-5S questionnaires were recorded pre-PAE and at 6 weeks, 3 months, and 1 year. RESULTS The mean age of patients was 68 (61-76). All patients had PAE as a day-case procedure. The technical success in the cohort was 23/24 (96%). There was a significant reduction in prostate volume following embolization with a median reduction of 34% (30-55) in the AdBPH group, compared to a mean volume reduction of 22% (9-44) in the non-AdBPH group (p = 0.04). There was a significant reduction in IPSS in the AdBPH group following PAE when compared with the control group [AdBPH median IPSS 8 (3-15) vs. non-AdBPH median IPSS 13 (8-18), p = 0.01]. IPSS QOL scores significantly improved in the AdBPH group (p = 0.007). There was no deterioration in sexual function in either group post-PAE. CONCLUSIONS This is the first time that AdBPH has been identified as being a predictor of clinical success following PAE.
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Affiliation(s)
- M W Little
- Department of Radiology, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
| | - P Boardman
- Department of Radiology, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - A C Macdonald
- Department of Radiology, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - N Taylor
- Department of Radiology, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - R Macpherson
- Department of Radiology, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - J Crew
- Department of Urology, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - C R Tapping
- Department of Radiology, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
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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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