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Guerra X, Sapoval M, Querub C, Al Ahmar M, Di Gaeta A, Dean C, Pellerin O, Boeken T. Repeat Prostatic Artery Embolization with the Addition of a Liquid Embolic Agent: Short-term Results. Acad Radiol 2024; 31:1959-1967. [PMID: 37996363 DOI: 10.1016/j.acra.2023.10.005] [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: 07/23/2023] [Revised: 09/27/2023] [Accepted: 10/03/2023] [Indexed: 11/25/2023]
Abstract
RATIONALE AND OBJECTIVES The long-term effectiveness of prostatic artery embolization (PAE) can be hampered by the recanalization of the previously embolized prostatic arteries (PA). The use of a liquid embolic agent (LEA) could limit this risk. The purpose of this study was to assess the safety and efficacy of repeat PAE (rePAE) using a LEA (Squid Peri) coupled with microspheres in patients experiencing recurring symptoms after initial embolization. MATERIALS AND METHODS This retrospective single-center study included all consecutive patients who underwent rePAE using Squid Peri coupled with microspheres. Angiographic patterns of prostatic revascularization were identified. Outcomes were assessed at the 3-month follow-up using the International Prostate Symptom Score (IPSS) and the Quality of Life (QoL) score. The primary endpoint was clinical success defined as an IPSS < 18 with > 25% decrease and a QoL score ≤ 3 with ≥ 1 point decrease. Safety was assessed by using the modified Clavien-Dindo classification. RESULTS 30 consecutive men (mean age: 67.1 ± 9.5 years) were included. Recanalization of the previously embolized PA was found in 83.3% of patients. Technical success was 93.3%. Median follow-up was 4.9 months [IQR: 3.9 - 9.8]. Clinical success rate was 76.7%, with a mean decrease in IPSS of -9.3 ± 7.3 (p < 0.001) and a median decrease in QoL of -2 [IQR: - 4 - - 1] (p < 0.001). One patient presented with an acute urinary retention requiring readmission (grade IIIa complication). CONCLUSION Repeat PAE using Squid Peri coupled with microspheres is safe and effective for patients with recurring symptoms after initial embolization.
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Affiliation(s)
- Xavier Guerra
- Vascular and oncological interventional radiology department, Georges Pompidou European Hospital, Assistance Publique - Hôpitaux de Paris, 20 Rue Leblanc, 75015, Paris, France; Université Paris Cité, Faculté de Santé, Paris, France.
| | - Marc Sapoval
- Vascular and oncological interventional radiology department, Georges Pompidou European Hospital, Assistance Publique - Hôpitaux de Paris, 20 Rue Leblanc, 75015, Paris, France; Université Paris Cité, Faculté de Santé, Paris, France; PARCC U 970, INSERM, Paris, France
| | - Charles Querub
- Vascular and oncological interventional radiology department, Georges Pompidou European Hospital, Assistance Publique - Hôpitaux de Paris, 20 Rue Leblanc, 75015, Paris, France; Université Paris Cité, Faculté de Santé, Paris, France
| | - Marc Al Ahmar
- Vascular and oncological interventional radiology department, Georges Pompidou European Hospital, Assistance Publique - Hôpitaux de Paris, 20 Rue Leblanc, 75015, Paris, France
| | - Alessandro Di Gaeta
- Vascular and oncological interventional radiology department, Georges Pompidou European Hospital, Assistance Publique - Hôpitaux de Paris, 20 Rue Leblanc, 75015, Paris, France
| | - Carole Dean
- Vascular and oncological interventional radiology department, Georges Pompidou European Hospital, Assistance Publique - Hôpitaux de Paris, 20 Rue Leblanc, 75015, Paris, France
| | - Olivier Pellerin
- Vascular and oncological interventional radiology department, Georges Pompidou European Hospital, Assistance Publique - Hôpitaux de Paris, 20 Rue Leblanc, 75015, Paris, France; Université Paris Cité, Faculté de Santé, Paris, France; PARCC U 970, INSERM, Paris, France
| | - Tom Boeken
- Vascular and oncological interventional radiology department, Georges Pompidou European Hospital, Assistance Publique - Hôpitaux de Paris, 20 Rue Leblanc, 75015, Paris, France; Université Paris Cité, Faculté de Santé, Paris, France; HeKA team, INRIA, Paris, France
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Gemma L, Pecoraro A, Sebastianelli A, Spatafora P, Sessa F, Nicoletti R, Gravas S, Campi R, Serni S, Gacci M. Impact of minimally invasive surgical procedures for Male Lower Urinary Tract Symptoms due to benign prostatic hyperplasia on ejaculatory function: a systematic review. Prostate Cancer Prostatic Dis 2024:10.1038/s41391-024-00795-2. [PMID: 38355729 DOI: 10.1038/s41391-024-00795-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 01/10/2024] [Accepted: 01/16/2024] [Indexed: 02/16/2024]
Abstract
BACKGROUND Surgical treatments for lower urinary tract symptoms (LUTS) due to benign prostatic obstruction (BPO) are affected by potentially bothersome side effects on sexual, and, above all, ejaculatory function. Several minimally invasive techniques have been proposed in the last years in order to overcome these consequences. Our aim is to summarize and evaluate the efficacy on LUTS relieve and the impact on sexual/ejaculatory function of Rezum, prostate artery embolization (PAE), implantation of a prostatic urethral lift (PUL) and the temporary implantable nitinol device (TIND). METHODS A systematic review of the English-language literature was conducted using the MEDLINE, Embase, and Web of Science databases from January 2000 to October 2022, according to the PRISMA guidelines (PROSPERO ID: CRD42023466515). Randomized controlled trials (RCTs), prospective studies and non-comparative or comparative studies assessing the impact on functional and ejaculatory function after minimally invasive surgical therapies for Male LUTS were evaluated. Risk of bias assessment was performed according to the Risk of Bias in Non-Randomized Studies of Interventions (ROBINS-I) tool for comparative studies, and the revised Cochrane risk-of-bias tool for randomized trials (RoB 2) for RCTs. RESULTS Overall, 47 studies were included (n = 4 for TIND; n = 9 for Rezum; n = 13 for PUL; n = 21 for PAE). Most studies relied on prospective patient cohorts and were rated as low risk of bias. Across studies assessing the efficacy of Rezum, a significant improvement in terms of IPSS (ranging from -47% to -56%) and Qmax (ranging from +39% to +87%) was reported. On the other hand, according to IIEF-5 score, Rezum had a minimal impact on sexual function (ranging from -1% to -3%). PUL showed a positive impact on IPSS (ranging from -35% to -58.2%) and Qmax (ranging from +49.9% to +114.7%) and sexual function. Finally, PAE showed encouraging functional results with IPSS score reducing from -12.8% to 63.3% and Qmax improving from +8% to 114.9% but the available evidence regarding the potential impact of PAE on sexual outcomes were limited. CONCLUSION Rezum, PAE, PUL and TIND are safe and feasible techniques associated with a significant functional improvement. While available data suggest a minimal impact of Rezum and PUL on ejaculatory function, the evidence after PAE and TIND are still limited. Therefore, our review lays the foundation for further research aiming to identify the criteria to select best candidates for uMIST to tailor the management in light of specific patient- and disease- factors.
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Affiliation(s)
- Luca Gemma
- Department of Urological Minimally Invasive, Robotic Surgery and Kidney Transplantation, Careggi Hospital, University of Florence, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Alessio Pecoraro
- Department of Urological Minimally Invasive, Robotic Surgery and Kidney Transplantation, Careggi Hospital, University of Florence, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Arcangelo Sebastianelli
- Department of Urological Minimally Invasive, Robotic Surgery and Kidney Transplantation, Careggi Hospital, University of Florence, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Pietro Spatafora
- Department of Urological Minimally Invasive, Robotic Surgery and Kidney Transplantation, Careggi Hospital, University of Florence, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Francesco Sessa
- Department of Urological Minimally Invasive, Robotic Surgery and Kidney Transplantation, Careggi Hospital, University of Florence, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Rossella Nicoletti
- Department of Urological Minimally Invasive, Robotic Surgery and Kidney Transplantation, Careggi Hospital, University of Florence, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Stavros Gravas
- Department of Urology, Medical School, University of Cyprus, Nicosia, Cyprus
| | - Riccardo Campi
- Department of Urological Minimally Invasive, Robotic Surgery and Kidney Transplantation, Careggi Hospital, University of Florence, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Sergio Serni
- Department of Urological Minimally Invasive, Robotic Surgery and Kidney Transplantation, Careggi Hospital, University of Florence, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Mauro Gacci
- Department of Urological Minimally Invasive, Robotic Surgery and Kidney Transplantation, Careggi Hospital, University of Florence, Florence, Italy.
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.
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Șerbănoiu A, Nechifor R, Marinescu AN, Iana G, Bratu AM, Sălcianu IA, Ion RT, Filipoiu FM. Prostatic Artery Origin Variability: Five Steps to Improve Identification during Percutaneous Embolization. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:2122. [PMID: 38138225 PMCID: PMC10744981 DOI: 10.3390/medicina59122122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 11/30/2023] [Accepted: 11/30/2023] [Indexed: 12/24/2023]
Abstract
Background and Objectives: The purpose of the current paper is to present our study on the variability in the prostatic artery origin, discuss the less frequent origins, and present the challenges of the prostatic artery embolization (PAE) procedure, thus aiding young interventional radiologists. Materials and Methods: We studied the origins of the prostatic artery on digital subtraction angiography (DSA) examinations from PAE procedures on 35 male pelvises (70 hemi-pelvises). Results: Our study has demonstrated that the most frequent origin of the prostatic artery (PA) is the internal pudendal artery (IPA), 37.1%, followed by the anterior gluteal trunk, 27.1%, and the superior vesical artery (SVA), 21.4%. Less frequent origins are the obturator artery (OBT), 11.4%, and the inferior gluteal artery (IGA), 2.8%. Conclusions: Compared to other studies, we notice some differences in the statistical results, but the most frequent origins remain the same. What is more important for young interventional radiologists is to be aware of all the possible origins of the PA in order to be able to offer a proper treatment to their patients. The important aspect that will ensure the success of the procedure without post-procedural complications is represented by the successful embolization of the targeted prostatic parenchyma.
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Affiliation(s)
- Alexandru Șerbănoiu
- Department of Radiology and Medical Imaging, University of Medicine and Pharmacy Carol Davila, 050474 Bucharest, Romania; (A.Ș.)
- Department of Radiology and Medical Imaging, University Emergency Hospital Bucharest, 050098 Bucharest, Romania
- Doctoral School of “Carol Davila”, University of Medicine and Pharmacy, 700115 Bucharest, Romania
| | - Rareș Nechifor
- Endovascular Network Bucharest, 075100, Bucharest, Romania
| | - Andreea Nicoleta Marinescu
- Department of Radiology and Medical Imaging, University of Medicine and Pharmacy Carol Davila, 050474 Bucharest, Romania; (A.Ș.)
- Department of Radiology and Medical Imaging, University Emergency Hospital Bucharest, 050098 Bucharest, Romania
| | - Gheorghe Iana
- Department of Radiology and Medical Imaging, University of Medicine and Pharmacy Carol Davila, 050474 Bucharest, Romania; (A.Ș.)
| | - Ana Magdalena Bratu
- Department of Radiology and Medical Imaging, University of Medicine and Pharmacy Carol Davila, 050474 Bucharest, Romania; (A.Ș.)
- Department of Radiology and Medical Imaging, Colțea Hospital,030171 Bucharest, Romania
| | - Iulia Alecsandra Sălcianu
- Department of Radiology and Medical Imaging, University of Medicine and Pharmacy Carol Davila, 050474 Bucharest, Romania; (A.Ș.)
- Department of Radiology and Medical Imaging, Colțea Hospital,030171 Bucharest, Romania
| | - Radu Tudor Ion
- Department of Radiology and Medical Imaging, University of Medicine and Pharmacy Carol Davila, 050474 Bucharest, Romania; (A.Ș.)
- Department of Radiology and Medical Imaging, University Emergency Hospital Bucharest, 050098 Bucharest, Romania
- Doctoral School of “Carol Davila”, University of Medicine and Pharmacy, 700115 Bucharest, Romania
| | - Florin Mihail Filipoiu
- Department of Radiology and Medical Imaging, University of Medicine and Pharmacy Carol Davila, 050474 Bucharest, Romania; (A.Ș.)
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Pilan BF, de Assis AM, Moreira AM, Rodrigues VCDP, Rocha ADD, Carnevale FC. Prostatic Artery Embolization Using Polyethylene Glycol Microspheres: A 1-Year Follow-up Prospective Study Including 30 Patients. J Vasc Interv Radiol 2023; 34:2197-2202. [PMID: 37657501 DOI: 10.1016/j.jvir.2023.08.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 08/12/2023] [Accepted: 08/23/2023] [Indexed: 09/03/2023] Open
Abstract
PURPOSE To evaluate safety and effectiveness of prostatic artery embolization (PAE) using polyethylene glycol (PEG) microspheres in patients with moderate-to-severe benign prostatic hyperplasia (BPH). MATERIALS AND METHODS A single-center, prospective study of 30 patients who underwent PAE from August 2020 to December 2021 using PEG 400-μm microspheres was conducted. Patient evaluation data using International Prostate Symptom Score (IPSS), quality of life (QoL) score, prostate-specific antigen (PSA), peak urinary flow rate (Qmax), postvoid residual volume (PVR), and prostate volume (PV) at baseline and 3 and 12 months after PAE were obtained. RESULTS Bilateral PAE was performed in all patients. One patient had early clinical failure (3.3%) and another presented with lower urinary tract symptoms (LUTSs) recurrence (3.3%) at the 12-month follow-up. Twenty-eight patients (93.3%) experienced significant and durable LUTS improvement. Mean absolute (and relative) improvement at 3 and 12 months were: IPSS, 14.6 points (-69%) for both; QoL, 3.3 points (-70%) and 3.5 points (-74%); Qmax, 6.3 mL/s (+78%) and 8.6 mL/s (+100%); PSA reduction, 1.2 ng/mL (-22%) and 1.0 ng/mL (-15%); PVR reduction, 48 mL (-56%) and 58.2 mL (-49%); PV reduction, 23.4 cm3 (-29%) and 19.6cm3 (-25%); (P < .05 for all). No major adverse events were observed. Minor adverse events included urinary tract infection (4/30, 13.3%), prostatic tissue elimination (3/30, 10%), penile punctiform ulcer (1/30, 3.3%), and urinary retention (1/30, 3.3%). CONCLUSIONS PAE using PEG microspheres was observed to be effective with sustained LUTS improvement at the 12-month follow-up. The incidence of urinary infection and prostatic tissue elimination was higher than previously reported for other embolics.
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Affiliation(s)
- Bruna Ferreira Pilan
- Department of Radiology and Oncology, University of São Paulo Medical School, São Paulo, Brazil.
| | - André Moreira de Assis
- Department of Radiology and Oncology, University of São Paulo Medical School, São Paulo, Brazil
| | - Airton Mota Moreira
- Department of Radiology and Oncology, University of São Paulo Medical School, São Paulo, Brazil
| | | | - Arthur Diego Dias Rocha
- Department of Radiology and Oncology, University of São Paulo Medical School, São Paulo, Brazil
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Chung E. Penile Glans Necrosis Following Prostatic Artery Embolization for Benign Prostatic Hyperplasia: Case Series and Review of Current Literature. World J Mens Health 2023; 41:396-402. [PMID: 35791297 PMCID: PMC10042657 DOI: 10.5534/wjmh.210244] [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: 12/04/2021] [Revised: 02/26/2022] [Accepted: 03/05/2022] [Indexed: 11/15/2022] Open
Abstract
PURPOSE To report a case series of 6 patients with penile glans necrosis (PGN) following prostatic artery embolization (PAE) and review the current literature relating to PAE and PGN, including the emerging role of hyperbaric oxygen therapy (HBOT) for PGN. MATERIALS AND METHODS All patients have failed medical BPH therapy and chose to undergo PAE over other minimally invasive BPH surgery. Patient demographics, preoperative and postoperative validated questionnaires such as the International Prostate Symptom Severity (IPSS) and International Index of Erectile Function (IIEF) scores, treatment-related adverse events (TRAE) and subsequent treatment for PGN were reviewed. All patients were follow-up with a minimum of 12 months post-PAE. RESULTS Between January 2018 and June 2020, six males with a mean age of 52.3 years (44-66 y) received PAE for BPH therapy. An immediate postoperative PGN was recognised in 4 out of 6 patients with the mean penile glans pain score of 3 and 4 patients reported altered penile glans sensitivity. Comparing the mean (and median) IPSS and IIEF-5 scores were 16.5 (16) and 21.3 (21) pre-PAE, there was improvements in IPSS and IIEF-5 scores at 12.0 (12) and 18.0 (18) at 12 months review. All patients reported normal penile glans sensitivity and only 1 patient reported an on-going penile glans pain (score 2). Four patients received HBOT while 2 patients elected for conservative care. All patients reported worse erectile function scores despite complete resolution of PGN. CONCLUSIONS PGN is a rare but serious complication of PAE with ensuing erectile dysfunction. HBOT appears to expedite the recovery process in men with PGN related to PAE with better erection scores compared to conservative measure.
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Affiliation(s)
- Eric Chung
- AndroUrology Centre, Brisbane, QLD and Sydney, NSW, Australia
- Department of Urology, Princess Alexandra Hospital, University of Queensland, Brisbane, QLD, Australia
- Department of Urology, Macquarie University Hospital, Sydney, NSW, Australia.
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Goyal P, Salem R, Mouli SK. Controversies in Prostate Artery Embolization: Future Best Practice. Semin Intervent Radiol 2022; 39:562-570. [PMID: 36561793 PMCID: PMC9767779 DOI: 10.1055/s-0042-1759701] [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: 12/24/2022]
Abstract
Prevalence of lower urinary tract symptoms secondary to benign prostatic hyperplasia is correlated with age. Men seeking treatment options with a low side effect profile often turn to prostate artery embolization (PAE). PAE continues to be refined with advanced tools and optimized techniques. Nonetheless, there exist controversies in terms of best practices for the management of lower urinary track symptoms (LUTS) with PAE. These controversies are essential for medical progress. Herein we suggest best practices moving forward based on currently available data. Given extensive safety data, we recommend PAE be considered alongside medical management and as a precursor to surgery. Given demonstrated efficacy across gland sizes, PAE can be performed in a single session, ideally in a hybrid angio-CT suite, without preoperative cross-sectional imaging. PAE should be initially performed with 300- to 500-μm size particles, and instead consider exploring other particles and sizes for repeat PAE. Finally, PAE can also be considered as first-line option for recurrent disease given the efficacy and excellent safety profile. This article is not meant to purport a dogma, but rather to serve as a guide to the experienced practitioner in challenging his or her own biases when performing PAE.
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Affiliation(s)
- Piyush Goyal
- Section of Interventional Radiology, Department of Radiology, Northwestern Feinberg School of Medicine, Chicago, Illinois
| | - Riad Salem
- Section of Interventional Radiology, Department of Radiology, Northwestern Feinberg School of Medicine, Chicago, Illinois
| | - Samdeep K. Mouli
- Section of Interventional Radiology, Department of Radiology, Northwestern Feinberg School of Medicine, Chicago, Illinois
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Bhatia S, Acharya V, Jalaeian H, Kumar J, Bryant E, Richardson A, Malkova K, Harward S, Sinha V, Kably I, Kava BR. Effect of Prostate Artery Embolization on Erectile Function - A Single Center Experience of 167 Patients. J Sex Med 2022; 19:594-602. [PMID: 35184995 DOI: 10.1016/j.jsxm.2022.01.006] [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: 08/12/2021] [Revised: 01/03/2022] [Accepted: 01/10/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Prostate artery embolization (PAE) is an emerging therapy for lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH). AIM This retrospective study was conducted to assess the effect of prostate artery embolization (PAE) on erectile function in a cohort of patients with LUTS attributable to BPH at 3-months after the procedure. METHODS A retrospective review was performed on 167 patients who underwent PAE. Data collected included Sexual Health Inventory in Men (SHIM) scores at 3, 6, and 12 months post-PAE, in conjunction with the International Prostate Symptom Scores (IPSS), Quality of Life (QoL) scores, and prostate volumes. Primary outcome was erectile function as assessed by SHIM scores at 3 months after PAE. An analysis was performed to identify patients with a ±5-point SHIM change to group them according to this minimum clinically significant difference in erectile function. Adverse events were recorded using the Clavien-Dindo (CD) classification. OUTCOMES At 3 months following PAE, median IPSS decreased by 16.0 [IQR, 9.0-22.0] points, median QOL decreased by 4.0 [IQR, 2.0-5.0] points, and median prostate volume decreased by 33 g [IQR, 14-55]. RESULTS Median SHIM score was 17.0 [IQR, 12.0-22.0] at baseline, 18.0 [IQR, 14.0-23.0] at 3 months [P = .031], 19.0 [IQR, 14.5-21.5] at 6 months [P = .106] and 20 [IQR, 16.0-24.0] at 12 months [P = .010] following PAE. In patients with no erectile dysfunction (ED) at baseline, 21% (n = 9) reported some degree of decline in erectile function post-PAE. However, 38% (n = 40) of patients who presented with mild-to-moderate ED reported improvement in their erectile function 3 months following PAE. Overall, the changes in baseline SHIM score were relatively small; 82% (n = 137) of patients did not have more than 5 points of change in their SHIM scores at 3 months following PAE. CLINICAL IMPLICATIONS Our findings suggest PAE has no adverse impact on erectile function for most patients. STRENGTHS & LIMITATIONS The study was performed at a single center with 1 operator's experience, and is retrospective with no control group. CONCLUSION Findings suggest that prostate artery embolization has no adverse effect on erectile function in the majority of patients with LUTS attributable to BPH at 3 months after the procedure. Bhatia S, Acharya V, Jalaeian H, et al., Effect of Prostate Artery Embolization on Erectile Function - A Single Center Experience of 167 Patients. J Sex Med 2022;19:594-602.
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Affiliation(s)
- Shivank Bhatia
- Department of Interventional Radiology, University of Miami, Miller School of Medicine, Miami, FL, USA
| | - Vedant Acharya
- University of Miami, Miller School of Medicine, Miami, FL, USA
| | - Hamed Jalaeian
- Department of Interventional Radiology, University of Miami, Miller School of Medicine, Miami, FL, USA
| | - Jessica Kumar
- Department of Interventional Radiology, University of Miami, Miller School of Medicine, Miami, FL, USA.
| | - Evan Bryant
- University of Miami, Miller School of Medicine, Miami, FL, USA
| | - Andrew Richardson
- Department of Interventional Radiology, University of Miami, Miller School of Medicine, Miami, FL, USA
| | - Kseniia Malkova
- Department of Interventional Radiology, University of Miami, Miller School of Medicine, Miami, FL, USA
| | - Sardis Harward
- University of Massachusetts Medical School, Worcester, MA, USA
| | - Vishal Sinha
- Weill Cornell Department of Radiology, New York, NY, USA
| | - Issam Kably
- Department of Interventional Radiology, University of Miami, Miller School of Medicine, Miami, FL, USA
| | - Bruce R Kava
- Department of Urology, University of Miami, Miller School of Medicine, Miami, FL, USA
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Galla N, Maron SZ, Voutsinas N, Sher A, Tangel M, Jue JS, Sharma H, Lookstein RA, Fischman AM, Rastinehad AR. Adjunctive Coil Embolization of the Prostatic Arteries After Particle Embolization for Prostatic Artery Embolization. Cardiovasc Intervent Radiol 2021; 44:1994-1998. [PMID: 34561744 PMCID: PMC8475843 DOI: 10.1007/s00270-021-02964-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Accepted: 08/30/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE To describe the feasibility, safety and short-term results of prostatic artery embolization (PAE) performed with adjunctive coil embolization of the main prostatic arteries (PA) following particle embolization. MATERIALS AND METHODS A total of 95 patients who underwent PAE with adjunctive bilateral coil embolization of the PAs following particle embolization between September 2018 and May 2021 were included. The patients had a mean prostate size of 115 ± 64 ml, 18/95 with hematuria symptoms, and 16/95 with indwelling urinary catheters. Coil embolization was performed in the main PAs prior to the bifurcation into the anteromedial and posterolateral branches using detachable microcoils. International Prostate Symptoms Score (IPSS), quality of life (QOL), maximum flow rate (Qmax) and adverse events were recorded. RESULTS IPSS were improved by - 11.2 ± 7.9 (n = 49, P < 0.001) and QOL by - 2.4 ± 1.8 (n = 49, P < 0.001) over a mean follow-up of 10.7 ± 7.9 weeks. Qmax did not demonstrate statistical significance. Twelve patients with hematuria (67%) showed improvement or resolution and twelve patients with indwelling or intermittent catheters (75%) were no longer catheter dependent. Two patients underwent a repeat PAE. There were no adverse events which were attributable to coil embolization. CONCLUSION Adjunctive coil embolization of the main PAs following particle embolization is a technically feasible technique with similar short-term clinical outcomes compared to prior studies. This novel technique warrants further prospective investigation with controls.
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Affiliation(s)
- Naveen Galla
- Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, One Gustave L. Levy Place, Box 1234, New York, NY, 10029, USA
| | - Samuel Z Maron
- Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, One Gustave L. Levy Place, Box 1234, New York, NY, 10029, USA
| | - Nicholas Voutsinas
- Long Island Jewish Medical Center, Northwell Health, New Hyde Park, New York, NY, 11040, USA
| | - Alex Sher
- Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, One Gustave L. Levy Place, Box 1234, New York, NY, 10029, USA
| | - Matthew Tangel
- Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, One Gustave L. Levy Place, Box 1234, New York, NY, 10029, USA
| | - Joshua S Jue
- Lenox Hill Hospital, Northwell Health, New York, NY, 10022, USA
| | - Himanshu Sharma
- Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, One Gustave L. Levy Place, Box 1234, New York, NY, 10029, USA
| | - Robert A Lookstein
- Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, One Gustave L. Levy Place, Box 1234, New York, NY, 10029, USA
| | - Aaron M Fischman
- Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, One Gustave L. Levy Place, Box 1234, New York, NY, 10029, USA.
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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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LaRussa S, Pantuck M, Wilcox Vanden Berg R, Gaffney CD, Askin G, McClure T. Symptomatic Improvement of Lower Urinary Tract Symptoms of Benign Prostatic Hyperplasia: A Comparative Systematic Review and Meta-Analysis of 4 Different Minimally Invasive Therapies. J Vasc Interv Radiol 2021; 32:1328-1340.e11. [PMID: 34256123 DOI: 10.1016/j.jvir.2021.06.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 05/27/2021] [Accepted: 06/22/2021] [Indexed: 11/28/2022] Open
Abstract
PURPOSE To review and compare the outcomes of prostatic artery embolization (PAE) with 3 other minimally invasive surgical treatments for benign prostatic hyperplasia, including photoselective vaporization (PVP), prostatic urethral lift (PUL), and water vapor thermal therapy (WV). METHODS A literature review was used to identify 35 publications, which included 2,653 patients (studies, patients): PVP (13, 949), PUL (9, 577), WV (3, 330), and PAE (10, 728). The international prostate symptom score (IPSS) and the international index of erectile function (IIEF-5) and quality of life (QOL) scores were recorded at baseline, 6 months, and 12 months. Meta-analyses, pooling the standardized mean difference between scores recorded before and after treatment, were conducted for each modality and time point to assess the magnitude of a therapy's effect to yield pooled effect sizes. A negative score indicates IPSS and QOL improvement. A positive score indicates IIEF-5 improvement. RESULTS At 6 and 12 months, the IPSS and QOL were most improved after PVP, followed by that after PAE, PUL, and, lastly, WV (measured only at 12 months). Between 6 and 12 months, the IPSS and QOL improved with PAE and worsened with PVP and PUL. Only PAE demonstrated statistical improvement in the IIEF-5, which improved from 6 to 12 months. CONCLUSIONS PVP and PAE resulted in the largest improvements in the IPSS and QOL. Only PAE resulted in improvement of the IIEF-5.
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Affiliation(s)
- Samuel LaRussa
- Department of Interventional Radiology, Weill Cornell Medicine/New York Presbyterian, New York, New York; Department of Radiology, Einstein-Jacobi Medical Center, Bronx, New York
| | - Morgan Pantuck
- Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
| | | | | | - Gulce Askin
- Division of Biostatistics, Department of Population Health Sciences, and Weill Cornell Medicine, New York, New York
| | - Timothy McClure
- Department of Interventional Radiology, Weill Cornell Medicine/New York Presbyterian, New York, New York; Department of Urology, Weill Cornell Medicine/New York Presbyterian, New York, New York.
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11
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Ng BHS, Chung E. A state-of-art review on the preservation of sexual function among various minimally invasive surgical treatments for benign prostatic hyperplasia: Impact on erectile and ejaculatory domains. Investig Clin Urol 2021; 62:148-158. [PMID: 33660441 PMCID: PMC7940857 DOI: 10.4111/icu.20200392] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 10/11/2020] [Accepted: 11/08/2020] [Indexed: 12/27/2022] Open
Abstract
There is a strong association between benign prostatic hyperplasia (BPH)/lower urinary tract symptoms (LUTS) and sexual dysfunction. While transurethral resection of the prostate (TURP) is considered the standard BPH treatment, it is however associated with a high rate of erectile and ejaculatory dysfunctions. Over the past decade, new and novel minimally invasive BPH therapies have been shown to improve various parameters of voiding domains while minimizing adverse sexual effects. These minimally invasive BPH therapies can be largely be divided into those with cavitating technology (Rezum, Histotripsy, Aquablation), intra-prostatic injections (Botulinum neurotoxin Type A, Fexapotide Triflutate, prostate specific antigen-activated protoxin PRX-302), and mechanical devices which include intraprostatic stents (Urospinal 2™, Memotherm™, Memokath™, and Allium triangular prostatic stent™) and intraprostatic devices (iTIND™, Urolift™), as well as prostatic artery embolization. Published literature on these technologies showed reasonable preservation of erectile function with limited data reported on ejaculatory domain. Further validation of the performance of these novel minimally invasive treatment options for LUTS due to BPH in well-designed and multi-centre studies are desired, to evaluate their role (or lack of such a role) in clinical practice and whether these BPH therapies can provide equivalent standard or better than TURP.
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Affiliation(s)
- Brian Hung Shin Ng
- Department of Urology, Princess Alexandra Hospital, University of Queensland, Brisbane, QLD, Australia
| | - Eric Chung
- Department of Urology, Princess Alexandra Hospital, University of Queensland, Brisbane, QLD, Australia.,AndroUroloogy Centre, Brisbane, QLD, Australia.,Department of Urology, Macquarie University Hospital, Sydney, NSW, Australia.
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12
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Lokeshwar SD, Valancy D, Lima TFN, Blachman-Braun R, Ramasamy R. A Systematic Review of Reported Ejaculatory Dysfunction in Clinical Trials Evaluating Minimally Invasive Treatment Modalities for BPH. Curr Urol Rep 2020; 21:54. [PMID: 33104947 DOI: 10.1007/s11934-020-01012-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2020] [Indexed: 12/30/2022]
Abstract
PURPOSE OF REVIEW To explore the sexual outcomes following the novel minimally invasive surgical procedures for benign prostatic hyperplasia- (BPH-) related lower urinary tract symptoms (LUTS), with an emphasis on ejaculatory dysfunction (EjD). RECENT FINDINGS A database search with a 10-year time restriction was carried out until February 20, 2020 using MEDLINE through the PubMed Platform evaluating minimally invasive treatment modalities for BPH and their effect on EjD. After the article selection, we retrieved data for men randomized in 19 different studies with results in 40 separate published articles investigating minimally invasive BPH surgery and reporting EjD rates. To date, water vapor thermal therapy or Rezūm, prostatic urethral lift (PUL) or UroLift®, prostate artery embolization (PAE), and Aquablation showed acceptable rates (< 2%) of retrograde ejaculation by 1 year and had very low adverse events related to the procedure. Both PUL and Rezūm demonstrated lower rates when compared with PAE and Aquablation. With comparable sexual side effect profiles postoperatively, clinicians may determine which therapeutic modality is optimal for patients based on efficacy and cost-benefit. Further randomized clinical trials are required to directly compare the effect of novel minimally invasive surgical procedures for BPH-related LUTS on ejaculation and sexual function.
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Affiliation(s)
- Soum D Lokeshwar
- Department of Urology, Yale Univeristy School of Medicine, 333 Cedar Street, New Haven, CT, 06520-8058, USA
| | - David Valancy
- Department of Urology, Miller School of Medicine, University of Miami, 1120 NW 14th Street, 15th Floor, Miami, FL, 33136, USA
| | - Thiago Fernandes Negris Lima
- Department of Urology, Miller School of Medicine, University of Miami, 1120 NW 14th Street, 15th Floor, Miami, FL, 33136, USA
| | - Ruben Blachman-Braun
- Department of Urology, Miller School of Medicine, University of Miami, 1120 NW 14th Street, 15th Floor, Miami, FL, 33136, USA
| | - Ranjith Ramasamy
- Department of Urology, Miller School of Medicine, University of Miami, 1120 NW 14th Street, 15th Floor, Miami, FL, 33136, USA.
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13
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Kearns DJ, Boardman P, Tapping CR. Patterns of Reperfusion and Clinical Findings in Repeat Prostate Artery Embolisation for Recurrent Lower Urinary Tract Symptoms in Patients with Benign Prostatic Hyperplasia. Cardiovasc Intervent Radiol 2020; 44:95-101. [PMID: 33037455 DOI: 10.1007/s00270-020-02671-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 09/26/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE To present our experience of the patterns of revascularisation of the prostate and efficacy of repeat prostate artery embolisation (rPAE) in patients with recurrence of lower urinary tract symptoms. MATERIALS AND METHODS We retrospectively analysed 12 patients who underwent rPAE at a single centre between November 2015 and March 2020. The patients had their intraprocedural angiography and cone beam CT images as well as their pre-procedural CT retrospectively reviewed to establish the patterns of revascularisation. Clinical follow-up occurred at a minimum of 3 months. RESULTS 11/12 patients (91.6%) had significant international prostate symptom score (IPSS) reduction following rPAE with change in mean IPSS from 18.4 to 8.1 at 3 months (p < 0.0001). Mean prostate volume was reduced by 41.6% (p = 0.03). 8/12 (75%) had a complete clinical success. 20/24 hemiprostates demonstrated revascularisation angiographically, of which 16 (80%) had prostatic arterial supply at rPAE by the main prostatic artery. Other mechanisms of revascularisation included supply from capsular prostatic artery branches and supply from other internal iliac pelvic branches. Unilateral embolisation at rPAE, where bilateral embolisation was not feasible (4/12), resulted in no difference in clinical outcomes compared with bilateral rPAE (p = 0.55). CONCLUSION We have found rPAE to be an effective treatment for recurrent lower urinary tract symptoms in patients who had good clinical response to initial PAE. The mechanisms of revascularisation are variable, but most patients that underwent rPAE had recanalisation of their main prostatic artery.
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Affiliation(s)
- Daniel J Kearns
- Department of Interventional Radiology, Churchill Hospital, Oxford University Hospitals Trust, Oxford, UK.
| | - Philip Boardman
- Department of Interventional Radiology, Churchill Hospital, Oxford University Hospitals Trust, Oxford, UK
| | - Charles R Tapping
- Department of Interventional Radiology, Churchill Hospital, Oxford University Hospitals Trust, Oxford, UK
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Carnevale FC, de Assis AM, Moreira AM. Prostatic Artery Embolization: Equipment, Procedure Steps, and Overcoming Technical Challenges. Tech Vasc Interv Radiol 2020; 23:100691. [PMID: 33308534 DOI: 10.1016/j.tvir.2020.100691] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
In the last decade, prostatic artery embolization (PAE) established itself as a safe and effective treatment option for lower urinary tract symptoms (LUTS) attributed to benign prostate hyperplasia (BPH), with reproducible results across multiple centers and endorsement by important international societies. However, PAE is also known to be a technically demanding procedure. Accompanying the prevalence of benign prostate hyperplasia, the procedure is usually performed in older patients, in whom atherosclerosis and comorbidities are common features. Also, prostatic vascular anatomy is described to be complex and variable, and pelvic structures are deeply interconnected by anastomosis. Thus, PAE demands a deep familiarization with materials and devices, intraprocedure imaging techniques, microcatetherization skills and with the pelvic vascular anatomy. Especially in the beginning of the learning curve, the procedure can be time-consuming and related to high radiation exposure for both medical team and the patient. In this article, the main points of technical concern during PAE are described and discussed, such as the equipment needed, the effect of different embolic materials, patient's preparation for the procedure, arterial access sites, identifying and catheterizing the prostatic arteries, the embolization techniques, among others. Finally, the most frequent technical challenges are presented, and the possible strategies to overcome them are exemplified and discussed.
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Affiliation(s)
- Francisco Cesar Carnevale
- Interventional Radiology Department, Radiology Institute, University of Sao Paulo Medical School, São Paulo, SP, Brazil.
| | - André Moreira de Assis
- Interventional Radiology Department, Radiology Institute, University of Sao Paulo Medical School, São Paulo, SP, Brazil
| | - Airton Mota Moreira
- Interventional Radiology Department, Radiology Institute, University of Sao Paulo Medical School, São Paulo, SP, Brazil
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15
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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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16
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Kovács A, Bücker A, Grimm MO, Habermann CR, Katoh M, Massmann A, Mahnken AH, Meyer BC, Moche M, Reimer P, Teichgräber U, Wacker FK. Position Paper of the German Society for Interventional Radiology (DeGIR) on Prostatic Artery Embolization. ROFO-FORTSCHR RONTG 2020; 192:835-846. [PMID: 32615637 DOI: 10.1055/a-1183-5438] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND In recent years prostate artery embolization (PAE) evolved into a clinically established minimally invasive endovascular treatment option for lower urinary tract symptoms caused by benign prostate syndrome (BPS). METHODS In this interdisciplinary position paper, initiated by the steering group for research of the German Society for Interventional Radiology (IR), the method of PAE is presented and discussed in the context of current evidence. RESULTS PAE is a safe IR procedure for the treatment of BPS. In terms of symptom relief, measured with the IPSS (International Prostate Symptom Score), the PAE has comparable effect, similar to the historic gold standard, transurethral resection (TUR) of the prostate. With regard to reducing subvesical obstruction PAE is inferior to TUR, but does not limit subsequent surgery. Based on current evidence, PAE is recommended by the British National Institute for Health and Care Excellence as an alternative therapy. The feasibility under local anaesthesia and the preservation of sexual function are important arguments for patients in favour of interventional therapy. Patient selection and therapy concepts require close interdisciplinary collaboration between urologists and radiologists. CONCLUSION Effectiveness and safety of PAE for the treatment of BPS are proven. Further randomized trials should focus on long term outcome and help to identify most suitable indications for PAE. KEY POINTS · PAE, an endovascular procedure, is a patient-friendly, minimally invasive, alternative therapy option of the BPS. · PAE can reduce the symptoms of the lower urinary tract (LUTS), comparable to transurethral resection (TUR). The deobstructive and volume-reducing potential of the PAE is inferior to that of the TUR. · The main advantages of PAE are use of local anesthesia (no general anesthesia required), short patient recovery and maintenance of sexual function, including antegrade ejaculation.. · Based on current evidence PAE should be considered after conservative drug therapy and before TUR.. · The role of PAE in the context of other minimally invasive procedures (MIST) requires further evaluation with an open minded approach towards PAE.. · PAE is carried out by interventional radiologists, usually on a referral basis from urologists, and requires close interdisciplinary cooperation.. CITATION FORMAT · Kovacs A, Bücker A, Grimm M et al. Position Paper of the German Society for Interventional Radiology (DeGIR) on Prostatic Artery Embolization. Fortschr Röntgenstr 2020; 192: 835 - 846.
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Affiliation(s)
- Attila Kovács
- MediClin Robert Janker Clinic, Clinic of Diagnostic and Interventional Radiology and Neuroradiology, Bonn, Germany
| | - Arno Bücker
- Saarland University Medical Center, Clinic of Diagnostic and Interventional Radiology, Homburg/Saar, Germany
| | | | - Christian R Habermann
- Kath. Marienhospital Hamburg, Department of Diagnostic and Interventional Radiology, Hamburg, Germany
| | - Marcus Katoh
- Helios-Hospital Krefeld, Diagnostic and Interventional Radiology, Krefeld, Germany
| | - Alexander Massmann
- Saarland University Medical Center, Clinic of Diagnostic and Interventional Radiology, Homburg/Saar, Germany
| | - Andreas H Mahnken
- Marburg University Hospital, Clinic of Diagnostic and Interventional Radiology, Marburg, Germany
| | - Bernhard C Meyer
- Hannover Medical School, Department of Diagnostic and Interventional Radiology, Hannover, Germany
| | - Michael Moche
- Helios-Park-Klinikum Leipzig, Department of Interventional Radiology, Leipzig, Germany
| | - Peter Reimer
- Städtisches Klinikum Karlsruhe, Academic teaching hospital of the University of Freiburg, Institute of Diagnostic and Interventional Radiology, Karlsruhe, Germany
| | - Ulf Teichgräber
- Jena University Hospital, Department of Radiology, Jena, Germany
| | - Frank K Wacker
- Hannover Medical School, Department of Diagnostic and Interventional Radiology, Hannover, Germany
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Kenny AG, Pellerin O, Moussa N, Del Giudice C, Déan C, Sapoval M. Repeat Prostatic Artery Embolization. J Vasc Interv Radiol 2020; 31:1090-1095.e1. [DOI: 10.1016/j.jvir.2020.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 03/11/2020] [Accepted: 03/13/2020] [Indexed: 11/26/2022] Open
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Carnevale FC, Moreira AM, de Assis AM, Antunes AA, Cristina de Paula Rodrigues V, Srougi M, Cerri GG. Prostatic Artery Embolization for the Treatment of Lower Urinary Tract Symptoms Due to Benign Prostatic Hyperplasia: 10 Years' Experience. Radiology 2020; 296:444-451. [PMID: 32484416 DOI: 10.1148/radiol.2020191249] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Background Long-term experience with prostatic artery embolization (PAE) for benign prostatic hyperplasia remains limited. Purpose To evaluate the efficacy, safety, and long-term results of PAE for benign prostatic hyperplasia. Materials and Methods This retrospective single-center study was conducted from June 2008 to June 2018 in patients with moderate to severe benign prostatic hyperplasia-related symptoms. International Prostate Symptom Score (IPSS), quality-of-life score, maximum urinary flow rate, postvoid residual volume, prostate-specific antigen (PSA), and prostate volume were assessed. PAE was performed with 100-500-μm embolic microspheres. Mixed-model analysis of variance and Kaplan-Meyer method was accessed, as appropriate. Results A total of 317 consecutive men (mean age ± standard deviation, 65 years ± 8) were treated. Follow-up ranged from 3 months to 96 months (mean, 27 months). Bilateral and unilateral PAE was performed in 298 (94%) and 19 (6%) men, respectively. Early clinical failure occurred in six (1.9%) and symptom recurrence in 72 (23%) men at a median follow-up of 72 months. Mean maximum improvement was as follows: IPSS, 16 points ± 7; quality-of-life score, 4 points ± 1; prostatic volume reduction, 39 cm3 ± 39 (39% ± 29); maximum urinary flow rate, 6 mL/sec ± 10 (155% ± 293); and postvoid residual volume, 70 mL ± 121 (48% ± 81) (P < .05 for all). Unilateral PAE was associated with higher recurrence (42% vs 21%; P = .04). Baseline PSA was inversely related with recurrence (hazard ratio, 0.9 per nanograms per milliliter of PSA; 95% confidence interval [CI], 0.8, 0.9; P < .001). Embolization with combined particle sizes (100-500 μm) did not relate to symptom recurrence (hazard ratio, 0.4; 95% CI: 0.2, 1.1 for 100-500-μm group vs 300-500-μm group and hazard ratio, 0.4; 95% CI: 0.1, 1.5 for 100-500-μm group vs 100-300-μm group; P = .19).None of the patients presented with urinary incontinence or erectile dysfunction. Conclusion Prostatic artery embolization was a safe and effective procedure for benign prostatic hyperplasia with good long-term results for lower urinary tract symptoms. © RSNA, 2020 Online supplemental material is available for this article.
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Affiliation(s)
- Francisco Cesar Carnevale
- From the Department of Radiology (F.C.C., A.M.M., A.M.d.A., V.C.d.P.R., G.G.C.) and Division of Urology (A.A.A., M.S.), University of São Paulo Medical School, Av. Dr. Enéas Carvalho de Aguiar, 255, São Paulo, SP 05403-000, Brazil
| | - Airton Mota Moreira
- From the Department of Radiology (F.C.C., A.M.M., A.M.d.A., V.C.d.P.R., G.G.C.) and Division of Urology (A.A.A., M.S.), University of São Paulo Medical School, Av. Dr. Enéas Carvalho de Aguiar, 255, São Paulo, SP 05403-000, Brazil
| | - Andre Moreira de Assis
- From the Department of Radiology (F.C.C., A.M.M., A.M.d.A., V.C.d.P.R., G.G.C.) and Division of Urology (A.A.A., M.S.), University of São Paulo Medical School, Av. Dr. Enéas Carvalho de Aguiar, 255, São Paulo, SP 05403-000, Brazil
| | - Alberto Azoubel Antunes
- From the Department of Radiology (F.C.C., A.M.M., A.M.d.A., V.C.d.P.R., G.G.C.) and Division of Urology (A.A.A., M.S.), University of São Paulo Medical School, Av. Dr. Enéas Carvalho de Aguiar, 255, São Paulo, SP 05403-000, Brazil
| | - Vanessa Cristina de Paula Rodrigues
- From the Department of Radiology (F.C.C., A.M.M., A.M.d.A., V.C.d.P.R., G.G.C.) and Division of Urology (A.A.A., M.S.), University of São Paulo Medical School, Av. Dr. Enéas Carvalho de Aguiar, 255, São Paulo, SP 05403-000, Brazil
| | - Miguel Srougi
- From the Department of Radiology (F.C.C., A.M.M., A.M.d.A., V.C.d.P.R., G.G.C.) and Division of Urology (A.A.A., M.S.), University of São Paulo Medical School, Av. Dr. Enéas Carvalho de Aguiar, 255, São Paulo, SP 05403-000, Brazil
| | - Giovanni Guido Cerri
- From the Department of Radiology (F.C.C., A.M.M., A.M.d.A., V.C.d.P.R., G.G.C.) and Division of Urology (A.A.A., M.S.), University of São Paulo Medical School, Av. Dr. Enéas Carvalho de Aguiar, 255, São Paulo, SP 05403-000, Brazil
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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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20
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Kløw NE, Grøtta OJ, Bay D, Sandbæk G, Johansen TEB, Hagen T, Baco E. Outcome after prostatic artery embolization in patients with symptomatic benign prostatic hyperplasia. Acta Radiol 2019; 60:1175-1180. [PMID: 30450921 DOI: 10.1177/0284185118813709] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- Nils E Kløw
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway
- Department of Radiology, Division of Radiology and Nuclear Medicine, Oslo University Hospital, Norway
| | - Ole J Grøtta
- Department of Radiology, Division of Radiology and Nuclear Medicine, Oslo University Hospital, Norway
| | - Dag Bay
- Department of Radiology, Division of Radiology and Nuclear Medicine, Oslo University Hospital, Norway
| | - Gunnar Sandbæk
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway
- Department of Radiology, Division of Radiology and Nuclear Medicine, Oslo University Hospital, Norway
| | - Truls E Bjerklund Johansen
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway
- Department of Urology, Division of Surgery, Inflammation and Transplantation, Oslo University Hospital, Norway
| | - Thijs Hagen
- Department of Radiology, Division of Radiology and Nuclear Medicine, Oslo University Hospital, Norway
| | - Eduard Baco
- Department of Urology, Division of Surgery, Inflammation and Transplantation, Oslo University Hospital, Norway
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21
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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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22
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Thulasidasan N, Kok H, Elhage O, Clovis S, Popert R, Sabharwal T. Prostate artery embolisation: an all-comers, single-operator experience in 159 patients with lower urinary tract symptoms, urinary retention, or haematuria with medium-term follow-up. Clin Radiol 2019; 74:569.e1-569.e8. [DOI: 10.1016/j.crad.2019.03.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Accepted: 03/05/2019] [Indexed: 01/21/2023]
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23
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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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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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25
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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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26
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Cardarelli-Leite L, de Assis AM, Moreira AM, Antunes AA, Cerri GG, Srougi M, Carnevale FC. Impact of 5-Alpha-Reductase Inhibitors Use at the Time of Prostatic Artery Embolization for Treatment of Benign Prostatic Obstruction. J Vasc Interv Radiol 2019; 30:228-232. [DOI: 10.1016/j.jvir.2018.11.027] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 11/21/2018] [Accepted: 11/26/2018] [Indexed: 11/25/2022] Open
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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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28
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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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Amouyal G, Pellerin O, Del Giudice C, Dean C, Thiounn N, Sapoval M. Variants of Patterns of Intra- and Extra-prostatic Arterial Distribution of the Prostatic Artery Applied to Prostatic Artery Embolization: Proposal of a Classification. Cardiovasc Intervent Radiol 2018; 41:1664-1673. [DOI: 10.1007/s00270-018-2064-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 08/14/2018] [Indexed: 10/28/2022]
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30
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Franiel T, Aschenbach R, Trupp S, Lehmann T, von Rundstedt FC, Grimm MO, Teichgräber U. Prostatic Artery Embolization with 250-μm Spherical Polyzene-Coated Hydrogel Microspheres for Lower Urinary Tract Symptoms with Follow-up MR Imaging. J Vasc Interv Radiol 2018; 29:1127-1137. [PMID: 29910163 DOI: 10.1016/j.jvir.2018.03.014] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 03/01/2018] [Accepted: 03/02/2018] [Indexed: 01/10/2023] Open
Abstract
PURPOSE To evaluate clinical outcomes and possible MR imaging predictors of clinical success after prostatic artery embolization (PAE) with 250-μm hydrogel particles. MATERIALS AND METHODS During a span of 1.5 years, 30 patients with moderate to severe lower urinary tract symptoms were included in a prospective, nonrandomized study. Embolization of at least one prostatic artery was considered as technical success. International Prostate Symptom Score (IPSS), quality of life (QOL), peak urinary flow rate (Qmax), residual urine volume, prostate volume, prostate-specific antigen level, and International Index of Erectile Function (IIEF) were recorded at baseline and at 1, 3, and 6 months after PAE. Multiparametric MR imaging was performed before PAE (n = 25) and 1 day (n = 25), 1 month (n = 7), 3 months (n = 7), and 6 months (n = 22) after intervention. A Wilcoxon-Mann-Whitney test was used to assess changes over time, and Spearman rank-correlation coefficient was used for outcome prediction. RESULTS PAE was technically successful in 90% of patients (n = 27). Clinical success (IPSS < 18 with decrease > 25% and QOL score < 4 with decrease ≥ 1 or Qmax ≥ 15 mL/s and increase of ≥ 3.0 mL/s) rates were 59% (16 of 27), 63% (17 of 27), and 74% (20 of 27) after 1, 3, and 6 mo, respectively. IIEF scores did not differ significantly during follow-up. The following adverse events occurred after PAE: urethral burning (5 of 27), fever (2 of 27), and urethral bleeding, rectal bleeding, cystitis, and penile burning sensation (1 of 27 each). No statistical correlations between initial multiparametric MR imaging changes and clinical parameters after 6 months were found (P values from .14 to .98). CONCLUSIONS PAE with 250-μm hydrogel microspheres led to good clinical success after 6 months with a low complication rate. Significant MR imaging predictors of clinical success were not identified.
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Affiliation(s)
- Tobias Franiel
- Institute of Diagnostic and Interventional Radiology, Universitätsklinikum Jena, Am Klinikum 1, 07747 Jena, Germany.
| | - René Aschenbach
- Institute of Diagnostic and Interventional Radiology, Universitätsklinikum Jena, Am Klinikum 1, 07747 Jena, Germany
| | - Sarah Trupp
- Institute of Diagnostic and Interventional Radiology, Universitätsklinikum Jena, Am Klinikum 1, 07747 Jena, Germany
| | - Thomas Lehmann
- Institute of Statistical Medicine, Informatics and Documentation, Universitätsklinikum Jena, Am Klinikum 1, 07747 Jena, Germany
| | | | - Marc-Oliver Grimm
- Clinic and Polyclinic of Urology, Universitätsklinikum Jena, Am Klinikum 1, 07747 Jena, Germany
| | - Ulf Teichgräber
- Institute of Diagnostic and Interventional Radiology, Universitätsklinikum Jena, Am Klinikum 1, 07747 Jena, Germany
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Petrillo M, Pesapane F, Fumarola EM, Emili I, Acquasanta M, Patella F, Angileri SA, Rossi UG, Piacentini I, Granata AM, Ierardi AM, Carrafiello G. State of the art of prostatic arterial embolization for benign prostatic hyperplasia. Gland Surg 2018; 7:188-199. [PMID: 29770312 PMCID: PMC5938262 DOI: 10.21037/gs.2018.03.01] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Accepted: 02/25/2018] [Indexed: 12/15/2022]
Abstract
Prostatectomy via open surgery or transurethral resection of the prostate (TURP) is the standard treatment for benign prostatic hyperplasia (BPH). Several patients present contraindication for standard approach, individuals older than 60 years with urinary tract infection, strictures, post-operative pain, incontinence or urinary retention, sexual dysfunction, and blood loss are not good candidates for surgery. Prostatic artery embolization (PAE) is emerging as a viable method for patients unsuitable for surgery. In this article, we report results about technical and clinical success and safety of the procedure to define the current status.
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Affiliation(s)
- Mario Petrillo
- Diagnostic and Interventional Radiology Department, San Paolo Hospital, Università degli Studi di Milano, Milan, Italy
| | - Filippo Pesapane
- Diagnostic and Interventional Radiology Department, San Paolo Hospital, Università degli Studi di Milano, Milan, Italy
- Postgraduation School in Radiodiagnostics, Università degli Studi di Milano, Milan, Italy
| | - Enrico Maria Fumarola
- Diagnostic and Interventional Radiology Department, San Paolo Hospital, Università degli Studi di Milano, Milan, Italy
- Postgraduation School in Radiodiagnostics, Università degli Studi di Milano, Milan, Italy
| | - Ilaria Emili
- Postgraduation School in Radiodiagnostics, Università degli Studi di Milano, Milan, Italy
| | - Marzia Acquasanta
- Postgraduation School in Radiodiagnostics, Università degli Studi di Milano, Milan, Italy
| | - Francesca Patella
- Diagnostic and Interventional Radiology Department, San Paolo Hospital, Università degli Studi di Milano, Milan, Italy
- Postgraduation School in Radiodiagnostics, Università degli Studi di Milano, Milan, Italy
| | - Salvatore Alessio Angileri
- Diagnostic and Interventional Radiology Department, San Paolo Hospital, Università degli Studi di Milano, Milan, Italy
| | | | - Igor Piacentini
- Interventional Radiology Unit, E.O. Ospedale Galliera, Genova, Italy
| | | | - Anna Maria Ierardi
- Diagnostic and Interventional Radiology Department, San Paolo Hospital, Università degli Studi di Milano, Milan, Italy
| | - Gianpaolo Carrafiello
- Diagnostic and Interventional Radiology Department, San Paolo Hospital, Università degli Studi di Milano, Milan, Italy
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Prostatic artery embolization for benign prostatic obstruction: assessment of safety and efficacy. World J Urol 2018; 36:575-584. [PMID: 29445846 DOI: 10.1007/s00345-018-2220-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Accepted: 02/01/2018] [Indexed: 10/18/2022] Open
Abstract
PURPOSE Prostatic artery embolization (PAE) has seen a recent increase in interest as a treatment for men with benign prostatic obstruction (BPO). The appeal of this intervention lies in reported reduction in morbidity and its minimally invasive nature. The purpose of this review is to assess the safety and efficacy of PAE as a new treatment in BPO and explore risks surrounding its performance. METHODS A review of the literature was performed. Medical databases searched included PubMed, EMBASE, and Cochrane databases, limited to English, peer-reviewed articles. Search terms included prostatic artery embolization, lower urinary tracts symptoms, minimally invasive therapies, interventional radiology prostate, and benign prostatic hyperplasia. Articles were screened by two independent reviewers for content on development, methods, outcomes, and complications of PAE. RESULTS Suitability of patients to undergo PAE depends on review of patient history, pre-procedure visualisation of appropriate vascular anatomy and clinical parameters. Despite this selection of candidates favourable for procedural success, PAE is not without risk of complications, some of which can significantly affect patient quality of life. CONCLUSIONS Although initial findings show promise regarding safety and efficacy of PAE in improving symptom and quality-of-life scores, further investigation is required to establish durability of effect and the appropriate use of this experimental modality. There is currently limited robust evidence for the beneficial outcomes of PAE. Long-term follow-up studies will add to the evidence base to help further assess the feasibility of this procedure as an alternative to TURP.
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