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Sapoval MR, Bhatia S, Déan C, Rampoldi A, Carnevale FC, Bent C, Tapping CR, Bongiovanni S, Taylor J, Brower JS, Rush M, McWilliams JP, Little MW. Two-Year Outcomes of Prostatic Artery Embolization for Symptomatic Benign Prostatic Hyperplasia: An International, Multicenter, Prospective Study. Cardiovasc Intervent Radiol 2024:10.1007/s00270-024-03802-0. [PMID: 39230672 DOI: 10.1007/s00270-024-03802-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 06/25/2024] [Indexed: 09/05/2024]
Abstract
PURPOSE To describe clinical outcomes among patients with benign prostatic hyperplasia (BPH) 24 months following prostatic artery embolization (PAE). MATERIALS AND METHODS This was an international, multicenter, prospective trial of males with BPH with lower urinary tract symptoms (LUTS) or acute urinary retention (AUR) treated with PAE. The primary outcome was the 12 month change in the International Prostate Symptom Score (IPSS) for patients referred for bothersome LUTS, or urinary catheter independence for patients treated for AUR. Secondary outcome measures included changes in IPSS at 3 and 24 months, changes in quality of life (QoL), changes in the Sexual Health Inventory for Men (SHIM) questionnaire, technical success rate, and adverse events (AEs). Data were summarized using descriptive statistics. RESULTS Four hundred seventy-eight consecutive patients underwent PAE (bothersome LUTS: N = 405; AUR: N = 73), mean age was 70 years. For patients treated for bothersome LUTS, mean total IPSS at baseline was 21.8 and decreased to 9.3, 10.6, and 11.2 at 3, 12, and 24 months following PAE, respectively (all p < 0.001); QoL at baseline was 4.7 and decreased to 2.0, 2.1, and 2.3 at 3, 12, and 24 months, respectively (all p < 0.001). The mean SHIM score at baseline and 12 months following PAE was 13.8 and 13.9, respectively. Of the 73 patients treated for AUR, 48 (65.8%) had their indwelling catheter removed within 3 months of PAE and remained catheter free at 24 months. Fifty-five patients (11.5%) experienced ≥ 1 AE and 10 (2.1%) experienced a serious AE. CONCLUSION PAE is a safe and effective treatment for symptomatic BPH and LUTS. Level of Evidence Level 3 Trial registration ClinicalTrials.gov NCT03527589.
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Affiliation(s)
- Marc R Sapoval
- Department of Vascular and Oncological Interventional Radiology, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, 20 Rue Leblanc, 75015, Paris, France.
| | - Shivank Bhatia
- Department of Interventional Radiology, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Carole Déan
- Department of Vascular and Oncological Interventional Radiology, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, 20 Rue Leblanc, 75015, Paris, France
| | - Antonio Rampoldi
- Department of Interventional Radiology, Ospedale Niguarda Ca' Granda, Milan, Italy
| | - Francisco César Carnevale
- Department of Radiology, Instituto de Radiologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - Clare Bent
- Department of Interventional Radiology, Royal Bournemouth and Christchurch Hospital, Bournemouth, UK
| | | | - Simone Bongiovanni
- Department of Radiology, Azienda Ospedaliera S. Croce E Carle, Cuneo, Italy
| | - Jeremy Taylor
- Department of Interventional Radiology, Frimley Park Hospital, Surrey, UK
| | - Jayson S Brower
- Department of Radiology, Providence Sacred Heart, Spokane, WA, USA
| | - Michael Rush
- Holy Cross South Florida Medical Imaging, Fort Lauderdale, FL, USA
| | - Justin P McWilliams
- Division of Interventional Radiology, Department of Radiology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Mark W Little
- University Department of Radiology, Royal Berkshire Hospital, Reading, UK
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Brown N, Kiosoglous A, Castree S, Firouzmand S, McBean R, Walker DG, Wallace S, Kua B, Gianduzzo T, Esler RC, Campbell P, Schoeman J, Yaxley J. The 'Prostate Embolisation AS first-line therapY compAred to meDication in treatment naïVe men with prostAte eNlargement, a randomised ControllEd trial' (P-EASY ADVANCE): a randomised controlled trial of prostate embolisation vs medication for BPH. BJU Int 2024. [PMID: 39139009 DOI: 10.1111/bju.16479] [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: 08/15/2024]
Abstract
OBJECTIVE To compare prostate artery embolisation (PAE) to the combination of tamsulosin and dutasteride therapy as a potential first-line therapy for obstructive benign prostatic hyperplasia (BPH) in treatment-naïve patients in the 'Prostate Embolisation AS first-line therapY compAred to meDication in treatment naïVe men with prostAte eNlargement, a randomised ControllEd trial' (P-EASY ADVANCE). PATIENTS AND METHODS A total of 39 men with enlarged prostates, moderate-severe lower urinary tract symptoms (LUTS) and obstructed/equivocal urodynamic studies (UDS), and who had no prior treatment for BPH, were randomised to receive either combined medical therapy with tamsulosin and dutasteride (medication) or PAE. Follow-up UDS, International Prostate Symptom Score (IPSS), uroflowmetry and ultrasound were performed at short- to medium-term intervals following interventions and compared to baseline. RESULTS The medication and PAE treatment groups had similar baseline characteristics, including prostate volumes (87.8 and 85.4 mL respectively), maximum urinary flow rate (Qmax; 6.5 and 6.6 mL/s, respectively), IPSS (19.5 and 21, respectively) and obstructed UDS (79% and 74%, respectively). Both interventions improved voiding and bladder outflow obstruction from baseline, with more patients unobstructed after PAE (63%) compared to medication (28%) (P = 0.03). PAE patients had significantly greater reductions in prostate size (P < 0.001), incomplete emptying (P = 0.002), total IPSS (P = 0.032), Qmax (P = 0.006) and quality of life (P = 0.001). Altered ejaculation, erectile dysfunction and nausea were more common in the medication group. CONCLUSION Prostate artery embolisation was more effective than combined medical therapy at reducing urinary obstruction, decreasing prostate volume and improving LUTS in patients with BPH who had not previously been treated. This is the first randomised control study to compare PAE and combined medical therapy in exclusively treatment-naïve patients and raises the potential of PAE as an alternative early treatment option for BPH. Further randomised comparative trials are planned to further validate the role of PAE in mitigating obstructive BPH.
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Affiliation(s)
- Nicholas Brown
- The University of Queensland, Brisbane, Queensland, Australia
- I-MED Radiology, Brisbane, Queensland, Australia
| | - Anthony Kiosoglous
- Urology Craft Group, The Wesley Hospital, Auchenflower, Queensland, Australia
| | | | | | | | | | - Sean Wallace
- I-MED Radiology, Brisbane, Queensland, Australia
| | - Boon Kua
- Urology Craft Group, The Wesley Hospital, Auchenflower, Queensland, Australia
| | - Troy Gianduzzo
- Urology Craft Group, The Wesley Hospital, Auchenflower, Queensland, Australia
| | - Rachel C Esler
- Urology Craft Group, The Wesley Hospital, Auchenflower, Queensland, Australia
| | - Peter Campbell
- Urology Craft Group, The Wesley Hospital, Auchenflower, Queensland, Australia
| | - Joseph Schoeman
- Urology Craft Group, The Wesley Hospital, Auchenflower, Queensland, Australia
| | - John Yaxley
- The University of Queensland, Brisbane, Queensland, Australia
- Urology Craft Group, The Wesley Hospital, Auchenflower, Queensland, Australia
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Alizadeh LS, Radek D, Booz C, Verloh N, Yel I, Koch V, Martin S, Gruenewald LD, Dimitrova M, Vogl TJ. Prostatic Artery Embolization: Lessons From 551 Procedures at a Single-Center. Acad Radiol 2024:S1076-6332(24)00350-7. [PMID: 38862346 DOI: 10.1016/j.acra.2024.05.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Revised: 05/21/2024] [Accepted: 05/21/2024] [Indexed: 06/13/2024]
Abstract
RATIONALE AND OBJECTIVES This retrospective study evaluates the efficacy and safety of Prostatic Artery Embolization (PAE) for the treatment of benign prostatic hyperplasia (BPH) over five years at a single center, conducted by an experienced interventional radiologist. MATERIALS AND METHODS We analyzed 551 PAE interventions from January 2019 to July 2023. Key metrics included patient demographics, procedural details (radiation exposure, particle size), complication rates, pre- and post-interventional prostatic volume (PV), Prostate-specific Antigen (PSA) levels, International Prostate Symptom Score (IPSS), Quality of Life (QoL) scores and International Index of Erectile Function (IIEF) scores. We assessed data normality, performed group and paired sample comparisons, and evaluated correlations. RESULTS For 551 men, the average patient age was 68.81 ± 8.61 years undergoing bilateral embolization. The particle size predominantly used was 100-300 µm (n = 441). PAE lead to significant (p < .001) reduction of both PV (-9.67 ± 14.52 mL) and PSA level (-2,65 ± 1.56 ng/mL) between pre- and three months after PAE. Substantial improvement were observed for IPSS (-9 points) and QoL scores (-2 points), with stable IIEF scores. Only minor complications (n = 16) were reported, and no major complications were observed. Between the first PAE in 2019 and the routinely performed PAE in 2023 significant (p < .0001) reductions in fluoroscopy (-25.2%), and procedural times (-26.1%) were observed. CONCLUSION In conclusion, PAE is a safe and effective treatment for BPH, offering significant improvements in lower urinary tract symptoms (LUTS) and QoL while maintaining sexual function.
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Affiliation(s)
- Leona S Alizadeh
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Germany; Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Germany.
| | - David Radek
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Germany
| | - Christian Booz
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Germany; Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Germany
| | - Niklas Verloh
- Department of Diagnostic and Interventional Radiology, University Hospital Freiburg, Germany
| | - Ibrahim Yel
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Germany; Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Germany
| | - Vitali Koch
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Germany; Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Germany
| | - Simon Martin
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Germany; Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Germany
| | - Leon D Gruenewald
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Germany; Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Germany
| | - Mirela Dimitrova
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Germany; Division of Experimental Imaging, Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Germany
| | - Thomas J Vogl
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Germany
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Xhepa G, Sciacqua LV, Vanzulli A, Canì AE, Ascenti V, Ricoeur A, Ianniello AA, Inzerillo A, Nicotera P, Del Grande F, Ierardi AM, Carrafiello G. Prostate Artery Embolization (PAE) with Small Beads for the Treatment of Benign Prostatic Hyperplasia (BPH). J Pers Med 2024; 14:613. [PMID: 38929834 PMCID: PMC11205146 DOI: 10.3390/jpm14060613] [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: 05/22/2024] [Revised: 05/31/2024] [Accepted: 06/06/2024] [Indexed: 06/28/2024] Open
Abstract
Benign Prostatic Hyperplasia (BPH) is the most frequent cause of Lower Urinary Tract Symptoms (LUTSs) in elderly populations. Minimally invasive treatments of BPH are safe and effective and are gaining popularity among both professionals and patients. Prostate Artery Embolization (PAE) has proven to be effective in Trans-Urethral Resection of the Prostate (TURP) in terms of prostate volume reduction and LUTS relief. PAE entails the selective catheterization of the prostatic artery and later embolization of distal vessels with beads of various calibers. Universal consensus regarding the ideal particle size is yet to be defined. We retrospectively evaluated 24 consecutive patients (median age: 75 years; range: 59-86 years) treated with PAE at our institution from October 2015 to November 2022. Particles of different sizes were employed; 12 patients were treated with 40-120 µm particles, 5 with 100 µm, 5 with 100-300 µm and 2 with 250 µm. Technical success, defined as selective prostate artery catheterization and controlled release of embolizing beads, was achieved in all patients. Removal vs. retention of the urinary catheter at the first post-procedural urological visit was the main clinical objective. No major peri-procedural complications were recorded, with 56% of patients successfully removing the urinary catheter.
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Affiliation(s)
- Genti Xhepa
- Istituto di Imaging della Svizzera Italiana (IIMSI), Ente Ospedaliero Cantonale (EOC), 6900 Lugano, Switzerland;
- Interventional Radiology Unit, University Hospital of Geneva (HUG), 1205 Geneva, Switzerland;
| | - Lucilla Violetta Sciacqua
- Postgraduate School in Radiodiagnostics, University of Milan, 20122 Milan, Italy; (L.V.S.); (A.V.); (V.A.)
| | - Andrea Vanzulli
- Postgraduate School in Radiodiagnostics, University of Milan, 20122 Milan, Italy; (L.V.S.); (A.V.); (V.A.)
- Department of Radiology, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, 20133 Milan, Italy
| | - Andrea Enzo Canì
- Department of Diagnostic and Interventional Radiology, Ospedale di Garbagnate Milanese “Guido Salvini”, ASST Rhodense, 20024 Garbagnate Milanese, Italy;
| | - Velio Ascenti
- Postgraduate School in Radiodiagnostics, University of Milan, 20122 Milan, Italy; (L.V.S.); (A.V.); (V.A.)
| | - Alexis Ricoeur
- Interventional Radiology Unit, University Hospital of Geneva (HUG), 1205 Geneva, Switzerland;
| | | | - Agostino Inzerillo
- AOUP Paolo Giaccone, Biomedicine, Neuroscience and Advanced Diagnostic Department (BiND), University of Palermo, 90127 Palermo, Italy;
| | - Paolo Nicotera
- Radiology Unit, Ospedale di Circolo e Fondazione Macchi, University of Insubria, 21100 Varese, Italy;
| | - Filippo Del Grande
- Istituto di Imaging della Svizzera Italiana (IIMSI), Ente Ospedaliero Cantonale (EOC), 6900 Lugano, Switzerland;
- Facoltà di Scienze Biomediche, Campus Est, Università Della Svizzera Italiana (USI), 6900 Lugano, Switzerland
| | - Anna Maria Ierardi
- Department of Radiology, Foundation IRCCS Ca’ Granda-Ospedale Maggiore Policlinico, University of Milan, 20122 Milan, Italy; (A.M.I.); (G.C.)
| | - Gianpaolo Carrafiello
- Department of Radiology, Foundation IRCCS Ca’ Granda-Ospedale Maggiore Policlinico, University of Milan, 20122 Milan, Italy; (A.M.I.); (G.C.)
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Rostambeigi N, Crawford D, Golzarian J. Benefits and advances of Cone Beam CT use in prostatic artery embolization: review of the literature and pictorial essay. CVIR Endovasc 2024; 7:46. [PMID: 38744805 PMCID: PMC11093965 DOI: 10.1186/s42155-024-00459-1] [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: 03/25/2024] [Accepted: 05/04/2024] [Indexed: 05/16/2024] Open
Abstract
Prostatic artery embolization (PAE) has proven to be an efficacious treatment for urinary symptoms of benign prostatic hyperplasia. PAE is performed in a complex and challenging anatomical field which may pose difficulties from procedural standpoint. Cone beam computed tomography (CBCT) has been proposed as an invaluable tool during the PAE procedure. A review of different techniques and advancements, as well as demonstration of CBCT benefits via a pictorial overview of the salient examples is lacking. The techniques of CBCT are discussed herein and the virtual injection technology as an advancement in CBCT is discussed. To show the merits of CBCT in PAE, a pictorial overview of various clinical scenarios is presented where CBCT can be crucial in decision making. These scenarios are aimed at showing different benefits including identification of the origin of the prostatic artery and avoiding non-target embolization. Other benefits may include ensuring complete embolization of entire prostate gland as angiographic appearance alone can be inconclusive if it mimics a severely thickened bladder wall or ensuring adequate embolization of the median lobe to provide relief from "ball-valve" effect. Further examples include verification of embolization of the entire prostate when rare variants or multiple (> 2) arterial feeders are present.
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Affiliation(s)
- Nassir Rostambeigi
- Vascular and Interventional Radiology, Mallinckrodt Institute of Radiology, Washington University, St. Louis, USA, 510 South Kingshighway Blvd, MO, 63110.
| | - Daniel Crawford
- Vascular and Interventional Radiology, Mallinckrodt Institute of Radiology, Washington University, St. Louis, USA, 510 South Kingshighway Blvd, MO, 63110
| | - Jafar Golzarian
- Vascular and Interventional Radiology, North Star Vascular & Interventional / University of Minnesota, Golden Valley, USA
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Brandt TW, Luizzi JM, Caras RJ. Evaluation of Current Surgical BPH Interventions for Young and Elderly Men. Curr Urol Rep 2024; 25:79-91. [PMID: 38470547 DOI: 10.1007/s11934-024-01198-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/12/2024] [Indexed: 03/14/2024]
Abstract
PURPOSE OF REVIEW Benign prostatic hyperplasia affects the quality of life of a significant number of men, especially as they age. There are continuous innovations in the surgical management of benign prostatic hyperplasia, but many of these innovations are studied in the core population of men 50-70 years of age. This review focuses on the outliers of men aged 18-50 and 70 and older. RECENT FINDINGS Older populations have more comorbidities, higher rates of antithrombotic medications, and advanced symptoms. Properly selected older men can safely have significant objective and subjective improvement in their symptoms. The literature was scarce when evaluating younger men; however, ejaculatory preserving techniques are promising providing improvement in symptoms and preserving ejaculation. This review demonstrates that in properly selected elderly patients, improvements in quality of life while also providing safe surgical interventions can be achieved. Ejaculatory preservation techniques demonstrate promising results, but further studies are required to elucidate true outcomes.
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Affiliation(s)
- Timothy W Brandt
- Department of Urology, Madigan Army Medical Center, 9040A Jackson Ave, Tacoma, WA, 98431, USA
| | - Jacqueline M Luizzi
- Department of Education and Research, Madigan Army Medical Center, Tacoma, WA, USA
| | - Ronald J Caras
- Department of Urology, Madigan Army Medical Center, 9040A Jackson Ave, Tacoma, WA, 98431, USA.
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Svarc P, Stroomberg HV, Taudorf M, Brasso K, Lonn L, Røder A. Efficacy of High-Dose Dexamethasone in Reducing the Symptoms of Postembolization Syndrome Following Prostatic Artery Embolization: Results of a Double-Blind Randomized Controlled Trial. Cardiovasc Intervent Radiol 2024; 47:632-639. [PMID: 38233575 PMCID: PMC11074011 DOI: 10.1007/s00270-023-03650-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 12/11/2023] [Indexed: 01/19/2024]
Abstract
PURPOSE To evaluate the efficacy of a single perioperative dose of dexamethasone in reducing postembolization syndrome following prostatic artery embolization. MATERIALS AND METHODS We conducted a single-center double-blind randomized controlled trial from March 2021 to May 2022 (NCT04588857). Participants were randomized to receive either i.v. 24 mg dexamethasone or saline. The primary outcome measures were temperature, pain, and quality of life in the first 5 days following prostatic artery embolization. Sample size of 60 patients was needed for the assessment of primary outcomes. Participants were followed for 6 months and assessed for a variety of secondary outcome measures including inflammatory markers and lower urinary tract symptoms severity. RESULTS Due to lack of clinical effect and mild symptoms in the control group, the trial was terminated early. 31 participants (16 dexamethasone vs. 15 control) were enrolled and analyzed. A difference in mean temperature was observed on day 1 (37.23 ± 0.64 °C control vs 36.74 ± 0.41 °C dexamethasone, p = 0.02, 95% CI 0.09-0.89). Difference in pain (score out of 10) was seen only on day 5 (1.48 ± 1.2 control vs. 2.9 ± 2.24 dexamethasone, p = 0.04, 95% CI - 2.78-- 0.04). A difference in C-reactive protein values was observed on day 2 (108 [54-161] mg/l control vs 10 [5-33] mg/l dexamethasone, p < 0.01). No significant differences in other outcomes were observed. No side effects were recorded. CONCLUSIONS Twenty-four milligrams of dexamethasone bolus is safe but does not reduce postembolization syndrome following prostatic artery embolization.
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Affiliation(s)
- Petra Svarc
- Department of Radiology, Rigshospitalet, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Denmark.
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2100, Copenhagen, Denmark.
| | - Hein Vincent Stroomberg
- Copenhagen Prostate Cancer Center, Blegdamsvej 9, 2100, RigshospitaletCopenhagen, Denmark
- Section of Biostatistics, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Mikkel Taudorf
- Department of Radiology, Rigshospitalet, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2100, Copenhagen, Denmark
| | - Klaus Brasso
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2100, Copenhagen, Denmark
- Copenhagen Prostate Cancer Center, Blegdamsvej 9, 2100, RigshospitaletCopenhagen, Denmark
| | - Lars Lonn
- Department of Radiology, Rigshospitalet, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2100, Copenhagen, Denmark
| | - Andreas Røder
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2100, Copenhagen, Denmark
- Copenhagen Prostate Cancer Center, Blegdamsvej 9, 2100, RigshospitaletCopenhagen, Denmark
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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: 2] [Impact Index Per Article: 2.0] [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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9
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Müllhaupt G, Hechelhammer L, Graf N, Mordasini L, Schmid HP, Engeler DS, Abt D. Prostatic Artery Embolisation Versus Transurethral Resection of the Prostate for Benign Prostatic Obstruction: 5-year Outcomes of a Randomised, Open-label, Noninferiority Trial. Eur Urol Focus 2024:S2405-4569(24)00045-2. [PMID: 38531756 DOI: 10.1016/j.euf.2024.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Accepted: 03/07/2024] [Indexed: 03/28/2024]
Abstract
BACKGROUND AND OBJECTIVE Prostatic artery embolisation (PAE) and transurethral resection of the prostate (TURP) are two of the surgical options for treatment of lower urinary tract symptoms/benign prostatic obstruction (LUTS/BPO). Our aim was to compare the efficacy and safety of PAE and TURP for LUTS/BPO treatment at long-term follow-up. METHODS We conducted a randomised, open-label, single-centre trial at a Swiss tertiary care centre. The main outcome was the change in International Prostate Symptom Score (IPSS) after PAE versus TURP. Secondary outcomes included patient-reported outcomes, functional measures, and adverse events assessed at baseline and at 3, 6, 12, 24, and 60 mo. Between-group differences in the change from baseline to 5 yr were tested using two-sided Mann-Whitney and t tests. KEY FINDINGS AND LIMITATIONS Of the 103 patients with refractory LUTS/BPO who were randomised between 2014 and 2017, 18/48 who underwent PAE and 38/51 who underwent TURP reached the 60-mo follow-up visit. The mean reduction in IPSS from baseline to 5 yr was -7.78 points after PAE and -11.57 points after TURP (difference 3.79 points, 95% confidence interval [CI] -0.66 to 8.24; p = 0.092). TURP was superior for most patient-reported secondary outcomes except for erectile function. At 5 yr, PAE was less effective than TURP regarding objective parameters, such as the improvement in maximum urinary flow rate (3.59 vs 9.30 ml/s, difference -5.71, 95% CI -10.72 to -0.70; p = 0. 027) and reduction in postvoid residual volume (27.81 vs 219.97 ml; difference 192.15, 95% CI 83.79-300.51; p = 0.001). CONCLUSIONS AND CLINICAL IMPLICATIONS The improvement in LUTS/BPO at 5 yr after PAE was inferior to that achieved with TURP. The limitations of PAE should be considered during patient selection and counselling. PATIENT SUMMARY In this study, we show the long-term results of prostate artery embolisation (PAE) in comparison to transurethral resection of the prostate (TURP) for the treatment of benign prostate enlargement causing urinary symptoms. PAE shows good long-term results in properly selected patients, although the improvements are less pronounced than with TURP. This trial is registered on ClinicalTrials.gov as NCT02054013.
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Affiliation(s)
- Gautier Müllhaupt
- Department of Urology, St. Gallen Cantonal Hospital and School of Medicine, University of St. Gallen, St. Gallen, Switzerland; Department of Urology, Spital Thun, Thun, Switzerland.
| | - Lukas Hechelhammer
- Department of Radiology and Nuclear Medicine, St. Gallen Cantonal Hospital, St. Gallen, Switzerland
| | - Nicole Graf
- Biostatistics Department, Clinical Trials Unit, St. Gallen Cantonal Hospital, St. Gallen, Switzerland
| | - Livio Mordasini
- Department of Urology, St. Gallen Cantonal Hospital and School of Medicine, University of St. Gallen, St. Gallen, Switzerland; Uroviva Practice Sursee, Uroviva Group, Sursee, Switzerland
| | - Hans-Peter Schmid
- Department of Urology, St. Gallen Cantonal Hospital and School of Medicine, University of St. Gallen, St. Gallen, Switzerland
| | - Daniel S Engeler
- Department of Urology, St. Gallen Cantonal Hospital and School of Medicine, University of St. Gallen, St. Gallen, Switzerland
| | - Dominik Abt
- Department of Urology, St. Gallen Cantonal Hospital and School of Medicine, University of St. Gallen, St. Gallen, Switzerland; Department of Urology, Spitalzentrum Biel, Biel, Switzerland
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Ai S, Gao Q, Cheng G, Zhong P, Cheng P, Ren Y, Wang H, Zhu X, Guan S, Qu X. Construction of an Injectable Composite Double-Network Hydrogel as a Liquid Embolic Agent. Biomacromolecules 2024; 25:2052-2064. [PMID: 38426456 DOI: 10.1021/acs.biomac.3c01437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
Conventional embolists disreputably tend to recanalization arising from the low filling ratio due to their rigidity or instability. As a result, intelligent hydrogels with a tunable modulus may meaningfully improve the therapeutic efficacy. Herein, an injectable composite double-network (CDN) hydrogel with high shear responsibility was prepared as a liquid embolic agent by cross-linking poly(vinyl alcohol) (PVA) and carboxymethyl chitosan (CMC) via dynamic covalent bonding of borate ester and benzoic-imine. A two-dimensional nanosheet, i.e., layered double hydroxide (LDH), was incorporated into the network through physical interactions which led to serious reduction of yield stress for the injection of the hydrogel and the capacity for loading therapeutic agents like indocyanine green (ICG) and doxorubicin (DOX) for the functions of photothermal therapy (PTT) and chemotherapy. The CDN hydrogel could thus be transported through a thin catheter and further in situ strengthened under physiological conditions, like in blood, by secondarily cross-linking with phosphate ions for longer degradation duration and better mechanical property. These characteristics met the requirements of arterial interventional embolization, which was demonstrated by renal embolism operation on rabbits, and meanwhile favored the inhibition of subcutaneous tumor growth on an animal model. Therefore, this work makes a breakthrough in the case of largely reducing the embolism risks, thus affording a novel generation for interventional embolization.
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Affiliation(s)
- Shili Ai
- Center of Materials Science and Optoelectronics Engineering, College of Materials Science and Opto-Electronic Technology, University of Chinese Academy of Sciences, Beijing 101408, China
| | - Qinzong Gao
- Key Laboratory of Carcinogenesis and Translational Research, Peking University Cancer Hospital and Institute, Beijing 100142, China
| | - Gele Cheng
- Center of Materials Science and Optoelectronics Engineering, College of Materials Science and Opto-Electronic Technology, University of Chinese Academy of Sciences, Beijing 101408, China
- Duke Kunshan University, Suzhou, Jiangsu 215316, China
| | - Pengfei Zhong
- Hebei North University, Zhangjiakou, Hebei 075000, China
| | - Peiyu Cheng
- Department of Oncology, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing 100010, China
| | - Yingying Ren
- Center of Materials Science and Optoelectronics Engineering, College of Materials Science and Opto-Electronic Technology, University of Chinese Academy of Sciences, Beijing 101408, China
| | - Hao Wang
- Department of Oncology, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing 100010, China
| | - Xu Zhu
- Key Laboratory of Carcinogenesis and Translational Research, Peking University Cancer Hospital and Institute, Beijing 100142, China
| | - Shanyue Guan
- Key Laboratory of Photochemical Conversion and Optoelectronic Materials, Technical Institute of Physics and Chemistry, Chinese Academy of Sciences, Beijing 100190, China
| | - Xiaozhong Qu
- Center of Materials Science and Optoelectronics Engineering, College of Materials Science and Opto-Electronic Technology, University of Chinese Academy of Sciences, Beijing 101408, China
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11
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Ayyagari R, Rahman SZ, Grizzard K, Mustafa A, Staib LH, Makkia RS, Bhatia S, Bilhim T, Carnevale FC, Davis C, Fischman A, Isaacson A, McClure T, McWilliams J, Nutting C, Richardson A, Salem R, Sapoval M, Yu H. Multicenter Quantification of Radiation Exposure and Associated Risks for Prostatic Artery Embolization in 1476 Patients. Radiology 2024; 310:e231877. [PMID: 38441098 DOI: 10.1148/radiol.231877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2024]
Abstract
Background Prostatic artery embolization (PAE) is a safe, minimally invasive angiographic procedure that effectively treats benign prostatic hyperplasia; however, PAE-related patient radiation exposure and associated risks are not completely understood. Purpose To quantify radiation dose and assess radiation-related adverse events in patients who underwent PAE at multiple centers. Materials and Methods This retrospective study included patients undergoing PAE for any indication performed by experienced operators at 10 high-volume international centers from January 2014 to May 2021. Patient characteristics, procedural and radiation dose data, and radiation-related adverse events were collected. Procedural radiation effective doses were calculated by multiplying kerma-area product values by an established conversion factor for abdominopelvic fluoroscopy-guided procedures. Relationships between cumulative air kerma (CAK) or effective dose and patient body mass index (BMI), fluoroscopy time, or radiation field area were assessed with linear regression. Differences in radiation dose stemming from radiopaque prostheses or fluoroscopy unit type were assessed using two-sample t tests and Wilcoxon rank sum tests. Results A total of 1476 patients (mean age, 69.9 years ± 9.0 [SD]) were included, of whom 1345 (91.1%) and 131 (8.9%) underwent the procedure with fixed interventional or mobile fluoroscopy units, respectively. Median procedure effective dose was 17.8 mSv for fixed interventional units and 12.3 mSv for mobile units. CAK and effective dose both correlated positively with BMI (R2 = 0.15 and 0.17; P < .001) and fluoroscopy time (R2 = 0.16 and 0.08; P < .001). No radiation-related 90-day adverse events were reported. Patients with radiopaque implants versus those without implants had higher median CAK (1452 mGy [range, 900-2685 mGy] vs 1177 mGy [range, 700-1959 mGy], respectively; P = .01). Median effective dose was lower for mobile than for fixed interventional systems (12.3 mSv [range, 8.5-22.0 mSv] vs 20.4 mSv [range, 13.8-30.6 mSv], respectively; P < .001). Conclusion Patients who underwent PAE performed with fixed interventional or mobile fluoroscopy units were exposed to a median effective radiation dose of 17.8 mSv or 12.3 mSv, respectively. No radiation-related adverse events at 90 days were reported. © RSNA, 2024 See also the editorial by Mahesh in this issue.
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Affiliation(s)
- Raj Ayyagari
- From the Boston Medical Center, 75 Albany Street, Boston, MA 02118 (R.A.); Yale University School of Medicine, New Haven, Conn (S.Z.R., K.G., A.M., L.H.S., R.S.M.); University of Miami Miller School of Medicine, Miami, Fla (S.B., A.R.); Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal (T.B.); Universidade de São Paulo Faculdade de Medicina, São Paulo, Brazil (F.C.C.); University of South Florida Morsani College of Medicine, Tampa, Fla (C.D.); Icahn School of Medicine at Mount Sinai, New York, NY (A.F.); Prostate Centers Raleigh, Raleigh, NC (A.I.); Weill Cornell Medical College, New York, NY (T.M.); University of California Los Angeles David Geffen School of Medicine, Los Angeles, Calif (J.M.); Endovascular Consultants of Colorado, Lone Tree, Colo (C.N.); Northwestern University Feinberg School of Medicine, Evanston, Ill (R.S.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges-Pompidou, Paris, France (M.S.); and The University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC (H.Y.)
| | - Saumik Z Rahman
- From the Boston Medical Center, 75 Albany Street, Boston, MA 02118 (R.A.); Yale University School of Medicine, New Haven, Conn (S.Z.R., K.G., A.M., L.H.S., R.S.M.); University of Miami Miller School of Medicine, Miami, Fla (S.B., A.R.); Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal (T.B.); Universidade de São Paulo Faculdade de Medicina, São Paulo, Brazil (F.C.C.); University of South Florida Morsani College of Medicine, Tampa, Fla (C.D.); Icahn School of Medicine at Mount Sinai, New York, NY (A.F.); Prostate Centers Raleigh, Raleigh, NC (A.I.); Weill Cornell Medical College, New York, NY (T.M.); University of California Los Angeles David Geffen School of Medicine, Los Angeles, Calif (J.M.); Endovascular Consultants of Colorado, Lone Tree, Colo (C.N.); Northwestern University Feinberg School of Medicine, Evanston, Ill (R.S.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges-Pompidou, Paris, France (M.S.); and The University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC (H.Y.)
| | - Kevin Grizzard
- From the Boston Medical Center, 75 Albany Street, Boston, MA 02118 (R.A.); Yale University School of Medicine, New Haven, Conn (S.Z.R., K.G., A.M., L.H.S., R.S.M.); University of Miami Miller School of Medicine, Miami, Fla (S.B., A.R.); Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal (T.B.); Universidade de São Paulo Faculdade de Medicina, São Paulo, Brazil (F.C.C.); University of South Florida Morsani College of Medicine, Tampa, Fla (C.D.); Icahn School of Medicine at Mount Sinai, New York, NY (A.F.); Prostate Centers Raleigh, Raleigh, NC (A.I.); Weill Cornell Medical College, New York, NY (T.M.); University of California Los Angeles David Geffen School of Medicine, Los Angeles, Calif (J.M.); Endovascular Consultants of Colorado, Lone Tree, Colo (C.N.); Northwestern University Feinberg School of Medicine, Evanston, Ill (R.S.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges-Pompidou, Paris, France (M.S.); and The University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC (H.Y.)
| | - Adel Mustafa
- From the Boston Medical Center, 75 Albany Street, Boston, MA 02118 (R.A.); Yale University School of Medicine, New Haven, Conn (S.Z.R., K.G., A.M., L.H.S., R.S.M.); University of Miami Miller School of Medicine, Miami, Fla (S.B., A.R.); Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal (T.B.); Universidade de São Paulo Faculdade de Medicina, São Paulo, Brazil (F.C.C.); University of South Florida Morsani College of Medicine, Tampa, Fla (C.D.); Icahn School of Medicine at Mount Sinai, New York, NY (A.F.); Prostate Centers Raleigh, Raleigh, NC (A.I.); Weill Cornell Medical College, New York, NY (T.M.); University of California Los Angeles David Geffen School of Medicine, Los Angeles, Calif (J.M.); Endovascular Consultants of Colorado, Lone Tree, Colo (C.N.); Northwestern University Feinberg School of Medicine, Evanston, Ill (R.S.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges-Pompidou, Paris, France (M.S.); and The University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC (H.Y.)
| | - Lawrence H Staib
- From the Boston Medical Center, 75 Albany Street, Boston, MA 02118 (R.A.); Yale University School of Medicine, New Haven, Conn (S.Z.R., K.G., A.M., L.H.S., R.S.M.); University of Miami Miller School of Medicine, Miami, Fla (S.B., A.R.); Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal (T.B.); Universidade de São Paulo Faculdade de Medicina, São Paulo, Brazil (F.C.C.); University of South Florida Morsani College of Medicine, Tampa, Fla (C.D.); Icahn School of Medicine at Mount Sinai, New York, NY (A.F.); Prostate Centers Raleigh, Raleigh, NC (A.I.); Weill Cornell Medical College, New York, NY (T.M.); University of California Los Angeles David Geffen School of Medicine, Los Angeles, Calif (J.M.); Endovascular Consultants of Colorado, Lone Tree, Colo (C.N.); Northwestern University Feinberg School of Medicine, Evanston, Ill (R.S.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges-Pompidou, Paris, France (M.S.); and The University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC (H.Y.)
| | - Rasha S Makkia
- From the Boston Medical Center, 75 Albany Street, Boston, MA 02118 (R.A.); Yale University School of Medicine, New Haven, Conn (S.Z.R., K.G., A.M., L.H.S., R.S.M.); University of Miami Miller School of Medicine, Miami, Fla (S.B., A.R.); Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal (T.B.); Universidade de São Paulo Faculdade de Medicina, São Paulo, Brazil (F.C.C.); University of South Florida Morsani College of Medicine, Tampa, Fla (C.D.); Icahn School of Medicine at Mount Sinai, New York, NY (A.F.); Prostate Centers Raleigh, Raleigh, NC (A.I.); Weill Cornell Medical College, New York, NY (T.M.); University of California Los Angeles David Geffen School of Medicine, Los Angeles, Calif (J.M.); Endovascular Consultants of Colorado, Lone Tree, Colo (C.N.); Northwestern University Feinberg School of Medicine, Evanston, Ill (R.S.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges-Pompidou, Paris, France (M.S.); and The University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC (H.Y.)
| | - Shivank Bhatia
- From the Boston Medical Center, 75 Albany Street, Boston, MA 02118 (R.A.); Yale University School of Medicine, New Haven, Conn (S.Z.R., K.G., A.M., L.H.S., R.S.M.); University of Miami Miller School of Medicine, Miami, Fla (S.B., A.R.); Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal (T.B.); Universidade de São Paulo Faculdade de Medicina, São Paulo, Brazil (F.C.C.); University of South Florida Morsani College of Medicine, Tampa, Fla (C.D.); Icahn School of Medicine at Mount Sinai, New York, NY (A.F.); Prostate Centers Raleigh, Raleigh, NC (A.I.); Weill Cornell Medical College, New York, NY (T.M.); University of California Los Angeles David Geffen School of Medicine, Los Angeles, Calif (J.M.); Endovascular Consultants of Colorado, Lone Tree, Colo (C.N.); Northwestern University Feinberg School of Medicine, Evanston, Ill (R.S.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges-Pompidou, Paris, France (M.S.); and The University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC (H.Y.)
| | - Tiago Bilhim
- From the Boston Medical Center, 75 Albany Street, Boston, MA 02118 (R.A.); Yale University School of Medicine, New Haven, Conn (S.Z.R., K.G., A.M., L.H.S., R.S.M.); University of Miami Miller School of Medicine, Miami, Fla (S.B., A.R.); Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal (T.B.); Universidade de São Paulo Faculdade de Medicina, São Paulo, Brazil (F.C.C.); University of South Florida Morsani College of Medicine, Tampa, Fla (C.D.); Icahn School of Medicine at Mount Sinai, New York, NY (A.F.); Prostate Centers Raleigh, Raleigh, NC (A.I.); Weill Cornell Medical College, New York, NY (T.M.); University of California Los Angeles David Geffen School of Medicine, Los Angeles, Calif (J.M.); Endovascular Consultants of Colorado, Lone Tree, Colo (C.N.); Northwestern University Feinberg School of Medicine, Evanston, Ill (R.S.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges-Pompidou, Paris, France (M.S.); and The University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC (H.Y.)
| | - Francisco C Carnevale
- From the Boston Medical Center, 75 Albany Street, Boston, MA 02118 (R.A.); Yale University School of Medicine, New Haven, Conn (S.Z.R., K.G., A.M., L.H.S., R.S.M.); University of Miami Miller School of Medicine, Miami, Fla (S.B., A.R.); Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal (T.B.); Universidade de São Paulo Faculdade de Medicina, São Paulo, Brazil (F.C.C.); University of South Florida Morsani College of Medicine, Tampa, Fla (C.D.); Icahn School of Medicine at Mount Sinai, New York, NY (A.F.); Prostate Centers Raleigh, Raleigh, NC (A.I.); Weill Cornell Medical College, New York, NY (T.M.); University of California Los Angeles David Geffen School of Medicine, Los Angeles, Calif (J.M.); Endovascular Consultants of Colorado, Lone Tree, Colo (C.N.); Northwestern University Feinberg School of Medicine, Evanston, Ill (R.S.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges-Pompidou, Paris, France (M.S.); and The University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC (H.Y.)
| | - Clifford Davis
- From the Boston Medical Center, 75 Albany Street, Boston, MA 02118 (R.A.); Yale University School of Medicine, New Haven, Conn (S.Z.R., K.G., A.M., L.H.S., R.S.M.); University of Miami Miller School of Medicine, Miami, Fla (S.B., A.R.); Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal (T.B.); Universidade de São Paulo Faculdade de Medicina, São Paulo, Brazil (F.C.C.); University of South Florida Morsani College of Medicine, Tampa, Fla (C.D.); Icahn School of Medicine at Mount Sinai, New York, NY (A.F.); Prostate Centers Raleigh, Raleigh, NC (A.I.); Weill Cornell Medical College, New York, NY (T.M.); University of California Los Angeles David Geffen School of Medicine, Los Angeles, Calif (J.M.); Endovascular Consultants of Colorado, Lone Tree, Colo (C.N.); Northwestern University Feinberg School of Medicine, Evanston, Ill (R.S.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges-Pompidou, Paris, France (M.S.); and The University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC (H.Y.)
| | - Aaron Fischman
- From the Boston Medical Center, 75 Albany Street, Boston, MA 02118 (R.A.); Yale University School of Medicine, New Haven, Conn (S.Z.R., K.G., A.M., L.H.S., R.S.M.); University of Miami Miller School of Medicine, Miami, Fla (S.B., A.R.); Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal (T.B.); Universidade de São Paulo Faculdade de Medicina, São Paulo, Brazil (F.C.C.); University of South Florida Morsani College of Medicine, Tampa, Fla (C.D.); Icahn School of Medicine at Mount Sinai, New York, NY (A.F.); Prostate Centers Raleigh, Raleigh, NC (A.I.); Weill Cornell Medical College, New York, NY (T.M.); University of California Los Angeles David Geffen School of Medicine, Los Angeles, Calif (J.M.); Endovascular Consultants of Colorado, Lone Tree, Colo (C.N.); Northwestern University Feinberg School of Medicine, Evanston, Ill (R.S.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges-Pompidou, Paris, France (M.S.); and The University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC (H.Y.)
| | - Ari Isaacson
- From the Boston Medical Center, 75 Albany Street, Boston, MA 02118 (R.A.); Yale University School of Medicine, New Haven, Conn (S.Z.R., K.G., A.M., L.H.S., R.S.M.); University of Miami Miller School of Medicine, Miami, Fla (S.B., A.R.); Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal (T.B.); Universidade de São Paulo Faculdade de Medicina, São Paulo, Brazil (F.C.C.); University of South Florida Morsani College of Medicine, Tampa, Fla (C.D.); Icahn School of Medicine at Mount Sinai, New York, NY (A.F.); Prostate Centers Raleigh, Raleigh, NC (A.I.); Weill Cornell Medical College, New York, NY (T.M.); University of California Los Angeles David Geffen School of Medicine, Los Angeles, Calif (J.M.); Endovascular Consultants of Colorado, Lone Tree, Colo (C.N.); Northwestern University Feinberg School of Medicine, Evanston, Ill (R.S.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges-Pompidou, Paris, France (M.S.); and The University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC (H.Y.)
| | - Timothy McClure
- From the Boston Medical Center, 75 Albany Street, Boston, MA 02118 (R.A.); Yale University School of Medicine, New Haven, Conn (S.Z.R., K.G., A.M., L.H.S., R.S.M.); University of Miami Miller School of Medicine, Miami, Fla (S.B., A.R.); Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal (T.B.); Universidade de São Paulo Faculdade de Medicina, São Paulo, Brazil (F.C.C.); University of South Florida Morsani College of Medicine, Tampa, Fla (C.D.); Icahn School of Medicine at Mount Sinai, New York, NY (A.F.); Prostate Centers Raleigh, Raleigh, NC (A.I.); Weill Cornell Medical College, New York, NY (T.M.); University of California Los Angeles David Geffen School of Medicine, Los Angeles, Calif (J.M.); Endovascular Consultants of Colorado, Lone Tree, Colo (C.N.); Northwestern University Feinberg School of Medicine, Evanston, Ill (R.S.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges-Pompidou, Paris, France (M.S.); and The University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC (H.Y.)
| | - Justin McWilliams
- From the Boston Medical Center, 75 Albany Street, Boston, MA 02118 (R.A.); Yale University School of Medicine, New Haven, Conn (S.Z.R., K.G., A.M., L.H.S., R.S.M.); University of Miami Miller School of Medicine, Miami, Fla (S.B., A.R.); Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal (T.B.); Universidade de São Paulo Faculdade de Medicina, São Paulo, Brazil (F.C.C.); University of South Florida Morsani College of Medicine, Tampa, Fla (C.D.); Icahn School of Medicine at Mount Sinai, New York, NY (A.F.); Prostate Centers Raleigh, Raleigh, NC (A.I.); Weill Cornell Medical College, New York, NY (T.M.); University of California Los Angeles David Geffen School of Medicine, Los Angeles, Calif (J.M.); Endovascular Consultants of Colorado, Lone Tree, Colo (C.N.); Northwestern University Feinberg School of Medicine, Evanston, Ill (R.S.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges-Pompidou, Paris, France (M.S.); and The University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC (H.Y.)
| | - Charles Nutting
- From the Boston Medical Center, 75 Albany Street, Boston, MA 02118 (R.A.); Yale University School of Medicine, New Haven, Conn (S.Z.R., K.G., A.M., L.H.S., R.S.M.); University of Miami Miller School of Medicine, Miami, Fla (S.B., A.R.); Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal (T.B.); Universidade de São Paulo Faculdade de Medicina, São Paulo, Brazil (F.C.C.); University of South Florida Morsani College of Medicine, Tampa, Fla (C.D.); Icahn School of Medicine at Mount Sinai, New York, NY (A.F.); Prostate Centers Raleigh, Raleigh, NC (A.I.); Weill Cornell Medical College, New York, NY (T.M.); University of California Los Angeles David Geffen School of Medicine, Los Angeles, Calif (J.M.); Endovascular Consultants of Colorado, Lone Tree, Colo (C.N.); Northwestern University Feinberg School of Medicine, Evanston, Ill (R.S.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges-Pompidou, Paris, France (M.S.); and The University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC (H.Y.)
| | - Andrew Richardson
- From the Boston Medical Center, 75 Albany Street, Boston, MA 02118 (R.A.); Yale University School of Medicine, New Haven, Conn (S.Z.R., K.G., A.M., L.H.S., R.S.M.); University of Miami Miller School of Medicine, Miami, Fla (S.B., A.R.); Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal (T.B.); Universidade de São Paulo Faculdade de Medicina, São Paulo, Brazil (F.C.C.); University of South Florida Morsani College of Medicine, Tampa, Fla (C.D.); Icahn School of Medicine at Mount Sinai, New York, NY (A.F.); Prostate Centers Raleigh, Raleigh, NC (A.I.); Weill Cornell Medical College, New York, NY (T.M.); University of California Los Angeles David Geffen School of Medicine, Los Angeles, Calif (J.M.); Endovascular Consultants of Colorado, Lone Tree, Colo (C.N.); Northwestern University Feinberg School of Medicine, Evanston, Ill (R.S.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges-Pompidou, Paris, France (M.S.); and The University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC (H.Y.)
| | - Riad Salem
- From the Boston Medical Center, 75 Albany Street, Boston, MA 02118 (R.A.); Yale University School of Medicine, New Haven, Conn (S.Z.R., K.G., A.M., L.H.S., R.S.M.); University of Miami Miller School of Medicine, Miami, Fla (S.B., A.R.); Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal (T.B.); Universidade de São Paulo Faculdade de Medicina, São Paulo, Brazil (F.C.C.); University of South Florida Morsani College of Medicine, Tampa, Fla (C.D.); Icahn School of Medicine at Mount Sinai, New York, NY (A.F.); Prostate Centers Raleigh, Raleigh, NC (A.I.); Weill Cornell Medical College, New York, NY (T.M.); University of California Los Angeles David Geffen School of Medicine, Los Angeles, Calif (J.M.); Endovascular Consultants of Colorado, Lone Tree, Colo (C.N.); Northwestern University Feinberg School of Medicine, Evanston, Ill (R.S.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges-Pompidou, Paris, France (M.S.); and The University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC (H.Y.)
| | - Marc Sapoval
- From the Boston Medical Center, 75 Albany Street, Boston, MA 02118 (R.A.); Yale University School of Medicine, New Haven, Conn (S.Z.R., K.G., A.M., L.H.S., R.S.M.); University of Miami Miller School of Medicine, Miami, Fla (S.B., A.R.); Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal (T.B.); Universidade de São Paulo Faculdade de Medicina, São Paulo, Brazil (F.C.C.); University of South Florida Morsani College of Medicine, Tampa, Fla (C.D.); Icahn School of Medicine at Mount Sinai, New York, NY (A.F.); Prostate Centers Raleigh, Raleigh, NC (A.I.); Weill Cornell Medical College, New York, NY (T.M.); University of California Los Angeles David Geffen School of Medicine, Los Angeles, Calif (J.M.); Endovascular Consultants of Colorado, Lone Tree, Colo (C.N.); Northwestern University Feinberg School of Medicine, Evanston, Ill (R.S.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges-Pompidou, Paris, France (M.S.); and The University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC (H.Y.)
| | - Hyeon Yu
- From the Boston Medical Center, 75 Albany Street, Boston, MA 02118 (R.A.); Yale University School of Medicine, New Haven, Conn (S.Z.R., K.G., A.M., L.H.S., R.S.M.); University of Miami Miller School of Medicine, Miami, Fla (S.B., A.R.); Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal (T.B.); Universidade de São Paulo Faculdade de Medicina, São Paulo, Brazil (F.C.C.); University of South Florida Morsani College of Medicine, Tampa, Fla (C.D.); Icahn School of Medicine at Mount Sinai, New York, NY (A.F.); Prostate Centers Raleigh, Raleigh, NC (A.I.); Weill Cornell Medical College, New York, NY (T.M.); University of California Los Angeles David Geffen School of Medicine, Los Angeles, Calif (J.M.); Endovascular Consultants of Colorado, Lone Tree, Colo (C.N.); Northwestern University Feinberg School of Medicine, Evanston, Ill (R.S.); Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges-Pompidou, Paris, France (M.S.); and The University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC (H.Y.)
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12
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Bhatia A, Porto JG, Maini A, Langade D, Herrmann TRW, Shah HN, Bhatia S. One-year outcomes after prostate artery embolization versus laser enucleation: A network meta-analysis. BJUI COMPASS 2024; 5:189-206. [PMID: 38371212 PMCID: PMC10869668 DOI: 10.1002/bco2.302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 09/11/2023] [Accepted: 09/26/2023] [Indexed: 02/20/2024] Open
Abstract
Background Although holmium laser enucleation (HoLEP) is considered a size-independent procedure for treatment of an enlarged prostate, prostate artery embolization (PAE) is emerging as an alternative modality to treat moderate and large benign prostatic hyperplasia. This study aims to compare the early post-operative and short-term efficacy of PAE and HoLEP. Methods PubMed, Cochrane Library and EMBASE databases were searched. Network meta-analysis was performed following PRISMA-N-guidelines. Post-operative parameters analysed include international prostate symptom score (IPSS), quality of life (QOL), post-void residual urine (PVR), maximal uroflow rate (Qmax) and serious adverse events (SAE). Random effects model calculated weighted mean differences (WMD). If 95%CI crossed the line of no effect (WMD = 0), evidence indicated no statistically significant difference between treatments compared. Results Qualitative and quantitative syntheses included 20 and 18 studies with 1991 and 1606 patients, respectively. At 3 months, there was no statistically significant difference between PAE and HoLEP in IPSS score improvement [WMD: -2.21: 95%CI: (-10.20, 5.78), favouring PAE], QoL score improvement [WMD: -0.22:95%CI: (-1.75, 1.32), favouring PAE] and PVR improvement [WMD: 26.97: 95%CI: (-59.53, 113.48), favouring HoLEP]. However, PAE was found inferior to HoLEP for Qmax improvement [WMD: 8.47, 95%CI: (2.89, 14.05), favouring HoLEP]. At 1-year follow-up, there was no statistically significant was found between PAE and HoLEP for IPSS score improvement [WMD:6.03, 95%CI: (-1.30, 13.35)], QoL score improvement [WMD: 0.03, 95%CI: (-1.19, 1.25)], PVR improvement [WMD:4.11, 95%CI: (-32.31, 40.53)] and Qmax improvement [WMD:2.60, 95%CI: (-2.20, 7.41)] with all differences favouring HoLEP. PAE was superior to HoLEP for SAE [PAE vs. HoLEP-OR: 0.68, 95%CI: (0.25, 1.37)]. Conclusion HoLEP was superior to PAE at 3 months for Qmax improvement. There was no significant difference in IPSS, QoL, PVR and Qmax improvement at 1 year between PAE and HoLEP. PAE was also associated with lesser SAE compared to HoLEP. Studies on the long-term outcome of PAE are needed to establish the durability of early outcomes after PAE.
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Affiliation(s)
- Ansh Bhatia
- Department of Interventional Radiology, Miller School of MedicineUniversity of MiamiMiamiFloridaUSA
- Seth GS Medical College and KEM HospitalMumbaiIndia
| | | | - Aneesha Maini
- School of MedicineGeorgetown UniversityWashingtonDistrict of ColumbiaUSA
| | | | - Thomas R. W. Herrmann
- Department of UrologySwitzerland Urology Spital Thurgau AG (STGAG)FrauenfeldSwitzerland
| | - Hemendra Navinchandra Shah
- Department of Urology, Desai Sethi Urology Institute, Miller School of MedicineUniversity of MiamiMiamiFloridaUSA
| | - Shivank Bhatia
- Department of Interventional Radiology, Miller School of MedicineUniversity of MiamiMiamiFloridaUSA
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13
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Martin A, Marcelin C, Petitpierre F, Jambon E, Maaloum R, Grenier N, Le Bras Y, Crombé A. Clinical, Technical, and MRI Features Associated with Patients' Outcome at 3 Months and 2 Years following Prostate Artery Embolization: Is There an Added Value of Radiomics? J Pers Med 2024; 14:67. [PMID: 38248768 PMCID: PMC10817287 DOI: 10.3390/jpm14010067] [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: 10/20/2023] [Revised: 12/26/2023] [Accepted: 01/03/2024] [Indexed: 01/23/2024] Open
Abstract
Our aim was to investigate which features were associated with clinical successes at short- and mid-terms following prostate artery embolization (PAE) for symptomatic benign prostate hypertrophy (BPH). All adults treated by PAE for BPH at our referral center between January 2017 and March 2021, with pre-treatment MRI, technical success, and follow-up at 3 months and 2 years were included in this single-center retrospective study. Radiologists reviewed the prostatic protrusion index (PPI), adenomatous dominant BPH (adBPH), and Wasserman classification on pre-treatment MRI. Radiomics analysis was achieved on the transitional zone on pre-treatment T2-weighted imaging (WI) and ADC, and comprised reproducibility assessment, unsupervised classifications, and supervised radiomics scores obtained with cross-validated Elasticnet regressions. Eighty-eight patients were included (median age: 65 years), with 81.8% clinical successes at 3 months and 60.2% at 2 years. No feature was associated with success at 3 months, except the radiomics score trained on T2-WI and ADC (AUROC = 0.694). Regarding success at 2 years, no radiomics approaches provided significant performances; however, Wasserman type-1 and change in international prostate symptom score (IPSS) at 3 months ≤ -35% were associated with success in multivariable analysis (OR = 5.82, p = 0.0296, and OR = 9.04, p = 0.0002). Thus, while radiomics provided limited interest, Wasserman classification and early IPSS changes appeared predictive of mid-term outcomes.
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Affiliation(s)
- Antoine Martin
- Department of Diagnostic and Interventional Radiology, Pellegrin University Hospital, Place Amélie-Raba-Léon, F-33076 Bordeaux, France (F.P.); (R.M.); (N.G.)
| | - Clément Marcelin
- Department of Diagnostic and Interventional Radiology, Pellegrin University Hospital, Place Amélie-Raba-Léon, F-33076 Bordeaux, France (F.P.); (R.M.); (N.G.)
- BRIC Bordeaux Institute of Oncology, INSERM U1312, 2 Rue Dr Hoffmann Martinot, F-33000 Bordeaux, France
| | - François Petitpierre
- Department of Diagnostic and Interventional Radiology, Pellegrin University Hospital, Place Amélie-Raba-Léon, F-33076 Bordeaux, France (F.P.); (R.M.); (N.G.)
- Department of Radiology, Clinique Mutualiste de Pessac, 46 Avenue du Dr Albert Schweitzer, F-33600 Pessac, France
| | - Eva Jambon
- Department of Diagnostic and Interventional Radiology, Pellegrin University Hospital, Place Amélie-Raba-Léon, F-33076 Bordeaux, France (F.P.); (R.M.); (N.G.)
| | - Rim Maaloum
- Department of Diagnostic and Interventional Radiology, Pellegrin University Hospital, Place Amélie-Raba-Léon, F-33076 Bordeaux, France (F.P.); (R.M.); (N.G.)
| | - Nicolas Grenier
- Department of Diagnostic and Interventional Radiology, Pellegrin University Hospital, Place Amélie-Raba-Léon, F-33076 Bordeaux, France (F.P.); (R.M.); (N.G.)
| | - Yann Le Bras
- Department of Diagnostic and Interventional Radiology, Pellegrin University Hospital, Place Amélie-Raba-Léon, F-33076 Bordeaux, France (F.P.); (R.M.); (N.G.)
| | - Amandine Crombé
- Department of Diagnostic and Interventional Radiology, Pellegrin University Hospital, Place Amélie-Raba-Léon, F-33076 Bordeaux, France (F.P.); (R.M.); (N.G.)
- BRIC Bordeaux Institute of Oncology, INSERM U1312, 2 Rue Dr Hoffmann Martinot, F-33000 Bordeaux, France
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14
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Bilhim T, McWilliams JP, Bagla S. Updated American Urological Association Guidelines for the Management of Benign Prostatic Hyperplasia: Prostatic Artery Embolization Made it into the Guidelines! Cardiovasc Intervent Radiol 2024; 47:150-153. [PMID: 38010505 DOI: 10.1007/s00270-023-03617-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 11/05/2023] [Indexed: 11/29/2023]
Affiliation(s)
- Tiago Bilhim
- Interventional Radiology Unit, Centro Hospitalar Universitário de Lisboa Central (CHULC), SAMS Hospital, Lisbon, Portugal.
| | | | - Sandeep Bagla
- Prostate Centers USA, 2755 Hartland Rd #110, Falls Church, VA, 22043, USA
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15
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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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16
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Sédat J, Arnoffi P, Poirier F, Jamjoom M, Raffaelli C, Colomb F, Chau Y. Non-target embolic events during prostatic embolization with ethylene vinyl alcohol copolymer (EVOH). CVIR Endovasc 2023; 6:54. [PMID: 37922055 PMCID: PMC10624789 DOI: 10.1186/s42155-023-00402-w] [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: 08/30/2023] [Accepted: 10/17/2023] [Indexed: 11/05/2023] Open
Abstract
BACKGROUND This study evaluated nontarget embolization (NTE) during prostatic artery embolization (PAE) with ethylene vinyl alcohol copolymer (EVOH). RESULTS Ten consecutive patients treated by PAE with EVOH for the presence of disabling benign prostatic hyperplasia (BPH)-related lower urinary tract symptoms (LUTS) between June 22 and January 2023 were included in this prospective study. The inclusion criteria were as follows: LUTS attributed to BPH, LUTS duration ≥ 6 months, failure to respond to standard pharmacotherapy, IPSS > 18 or QoL score > 2, and prostate volume > 40 mL. Embolization was performed under general anaesthesia. According to established techniques, a microcatheter was positioned bilaterally within the feeding arteries, and EVOH was injected slowly under X-ray control. Unenhanced pelvic computed tomography scans were carried out before and after embolization to assess the NTE. The safety of the prostatic embolization procedure with EVOH was assessed by collecting adverse effects over 3 months of evaluation that included the International Prostate Symptom Score (IPSS) and quality of life (QoL) score.-up evaluations, occurring at 3, 6, and 12months, included International Prostate Symptom Score. Bilateral PAE was technically successful in 9 patients, and unilateral injection was performed in one patient. The postoperative scanner showed a distribution of the embolization material in the two lobes of the prostate in all patients. The procedure time varied from 120 to 150 (mean: 132) minutes. Eight out of 10 patients developed pollakiuria within 24 h; none of the patients had postoperative pain. Two patients required catheterization for postoperative urinary retention. Catheters were removed successfully at the end of the first day for one of these patients and on the tenth day for the other. At the 3-month follow-up, patients showed significant improvement in the International Prostate Symptom Score (n = 10; mean = -11,5; P < 0.01) and quality of life score (n = 10; mean = -3,40; P < 0.01). Only one patient presented one asymptomatic muscular NTE. CONCLUSIONS PAE with EVOH is safe, effective, and associated with few NTEs and no postoperative pain. Prospective comparative studies with longer follow-ups are warranted. TRIAL REGISTRATION IDRCB, 2021-AO29-56-35. Registered 27 May 2022, http://clinicaltrials.gov/study/NCT05395299?cond=embolization&term&rank=1 .
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Affiliation(s)
- Jacques Sédat
- Service de NeuroInterventionnel, CHU de Nice Hôpital, Pasteur 2, 30 Voie Romaine, Nice, France.
| | - Paolo Arnoffi
- Service de NeuroInterventionnel, CHU de Nice Hôpital, Pasteur 2, 30 Voie Romaine, Nice, France
| | - Florent Poirier
- Service de NeuroInterventionnel, CHU de Nice Hôpital, Pasteur 2, 30 Voie Romaine, Nice, France
| | - Modhar Jamjoom
- Service de NeuroInterventionnel, CHU de Nice Hôpital, Pasteur 2, 30 Voie Romaine, Nice, France
| | - Charles Raffaelli
- Service de NeuroInterventionnel, CHU de Nice Hôpital, Pasteur 2, 30 Voie Romaine, Nice, France
| | - Frederic Colomb
- Hôpital de Grasse. Chemin de Clavary, Service d'urologie, 06130, Grasse, France
| | - Yves Chau
- Service de NeuroInterventionnel, CHU de Nice, Hôpital, Pasteur 2, 30 Voie Romaine, Nice, France
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17
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Fawzy NA, Cooper RS, Guan JJ. Prostatic Artery Embolization for Refractory Hematuria Secondary to Prostatic Varices. J Vasc Interv Radiol 2023; 34:2028-2030. [PMID: 37532094 DOI: 10.1016/j.jvir.2023.07.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 07/05/2023] [Accepted: 07/25/2023] [Indexed: 08/04/2023] Open
Affiliation(s)
- Nader A Fawzy
- Division of Interventional Radiology, Department of Radiology, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195
| | - Roy S Cooper
- UPMC Hamot, Department of Urology, University of Pittsburgh Medical Center, 100 Peach St, Erie, PA 16507
| | - Justin J Guan
- Division of Interventional Radiology, Department of Radiology, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195.
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18
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Capdevila F, Insausti I, San Miguel R, Sanchez-Iriso E, Montesino M. Cost-Utility Analysis of Prostatic Artery Embolization for Treatment of Lower Urinary Tract Symptoms. Cardiovasc Intervent Radiol 2023:10.1007/s00270-023-03443-9. [PMID: 37142802 DOI: 10.1007/s00270-023-03443-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Accepted: 04/05/2023] [Indexed: 05/06/2023]
Abstract
PURPOSE To perform a post hoc cost-utility analysis of a randomized controlled clinical trial comparing prostatic artery embolization (PAE) and transurethral resection of the prostate (TURP) in patients with lower urinary tract symptoms secondary to benign prostatic hyperplasia. MATERIALS AND METHODS We conducted a cost-utility analysis over a 5-year period to compare PAE versus TURP from a Spanish National Health System perspective. Data were collected from a randomized clinical trial performed at a single institution. Effectiveness was measured as quality-adjusted life years (QALYs), and an incremental cost-effectiveness ratio (ICER) was derived from the cost and QALY values associated with these treatments. Further sensitivity analysis was performed to account for the impact of reintervention on the cost-effectiveness of both procedures. RESULTS At the 1-year follow-up, PAE resulted in mean cost per patient of €2904.68 and outcome of 0.975 QALYs per treatment. In comparison, TURP had cost €3846.72 per patient and its outcome was 0.953 QALYs per treatment. At 5 years, the cost for PAE and TURP were €4117.13 and €4297.58, and the mean QALY outcome was 4.572 and 4.487, respectively. Analysis revealed an ICER of €2121.15 saved per QALY gained when comparing PAE to TURP at long-term follow-up. Reintervention rate for PAE and TURP was 12% and 0%, respectively. CONCLUSIONS Compared to TURP, in short term, PAE could be considered a cost-effective strategy within the Spanish healthcare system for patients with lower urinary tract symptoms secondary to benign prostatic hyperplasia. However, in long term, the superiority is less apparent due to higher reintervention rates.
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Affiliation(s)
- Ferran Capdevila
- Department of Pharmacy, University Hospital of Navarre (HUN), Calle Irunlarrea 3, 31008, Pamplona, Spain.
- Public University of Navarre (UPNA), Campus de Arrosadia, s/n, 31006, Pamplona, Spain.
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), Calle Irunlarrea 3, 31008, Pamplona, Spain.
| | - Iñigo Insausti
- Department of Radiology, University Hospital of Navarre (HUN), Calle Irunlarrea 3, 31008, Pamplona, Spain
| | - Ramon San Miguel
- Department of Pharmacy, University Hospital of Navarre (HUN), Calle Irunlarrea 3, 31008, Pamplona, Spain
- Public University of Navarre (UPNA), Campus de Arrosadia, s/n, 31006, Pamplona, Spain
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), Calle Irunlarrea 3, 31008, Pamplona, Spain
| | - Eduardo Sanchez-Iriso
- Public University of Navarre (UPNA), Campus de Arrosadia, s/n, 31006, Pamplona, Spain
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), Calle Irunlarrea 3, 31008, Pamplona, Spain
| | - Manuel Montesino
- Public University of Navarre (UPNA), Campus de Arrosadia, s/n, 31006, Pamplona, Spain
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), Calle Irunlarrea 3, 31008, Pamplona, Spain
- Department of Urology, University Hospital of Navarre (HUN), Calle Irunlarrea 3, 31008, Pamplona, Spain
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Lehrer R, Sapoval M, Di Gaeta A, Querub C, Al Ahmar M, Dean C, Pellerin O, Boeken T. Benefits of Repeat Prostatic Artery Embolization on Persistent or Recurrent Lower Urinary Tract Symptoms in Patients with Benign Prostatic Hyperplasia. Cardiovasc Intervent Radiol 2023:10.1007/s00270-023-03424-y. [PMID: 37029235 DOI: 10.1007/s00270-023-03424-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Accepted: 03/16/2023] [Indexed: 04/09/2023]
Abstract
OBJECTIVES To evaluate the benefits of repeat prostatic artery embolization (rePAE) for patients with persistent or recurrent symptoms after initial prostatic artery embolization (PAE). MATERIALS AND METHODS This is a single-center retrospective study of all patients who underwent a rePAE between December 2014 and November 2020 for persistent or recurrent lower urinary tract symptoms. Symptoms were assessed before and after PAE and rePAE, using the International Prostate Symptom Score and quality of life (QoL) questionnaires. Patient characteristics, anatomical presentations, technical success rates, and complications of both procedures were collected. Clinical failure was defined as one of the following: less than 2 points' decrease in QoL, a QoL score higher than 3, acute urinary retention, and secondary surgery. RESULTS A total of 21 consecutive patients (mean age: 63.8 ± 8.1; [40-75] years) who underwent rePAE were included. The median follow-up after PAE was 27.7 [18.1-36.9]) months and 8.9 [3.4-10.8] months after rePAE. rePAE was performed at a mean of 19 ± 11.1 [6.9-49.6] months following PAE, and the overall clinical success rate was 33% (7/21). In patients undergoing rePAE because of persistent symptoms, the clinical success rate (18%) was non-significantly lower than that for patients treated for recurrent symptoms (50%) [OR 4.5 (95% CI 0.63-32 P = 0.13)]. The main anatomical revascularization pattern was recanalization of the native prostatic artery (29/45, 66%). CONCLUSION Patients who experience recurrent symptoms after PAE may benefit more from rePAE than those with persistent symptoms after PAE. Clinical success rates seem to be relatively low in both clinical scenarios.
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Affiliation(s)
- Raphael Lehrer
- Vascular and Oncological Interventional Radiology, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France
| | - Marc Sapoval
- Vascular and Oncological Interventional Radiology, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France
- Faculté de Santé, Université de Paris Cité, Paris, France
- PARCC U 970, INSERM, Université de Paris Cité, Paris, France
| | - Alessandro Di Gaeta
- Vascular and Oncological Interventional Radiology, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France
| | - Charles Querub
- Vascular and Oncological Interventional Radiology, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France
- Faculté de Santé, Université de Paris Cité, Paris, France
| | - Marc Al Ahmar
- Vascular and Oncological Interventional Radiology, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France
| | - Carole Dean
- Vascular and Oncological Interventional Radiology, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France
- PARCC U 970, INSERM, Université de Paris Cité, Paris, France
| | - Olivier Pellerin
- Vascular and Oncological Interventional Radiology, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France
- Faculté de Santé, Université de Paris Cité, Paris, France
- PARCC U 970, INSERM, Université de Paris Cité, Paris, France
| | - Tom Boeken
- Vascular and Oncological Interventional Radiology, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France.
- Faculté de Santé, Université de Paris Cité, Paris, France.
- PARCC U 970, INSERM, Université de Paris Cité, Paris, France.
- HeKA Team, INRIA, Paris, France.
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Boschheidgen M, Al-Monajjed R, Minko P, Jannusch K, Ullrich T, Radke KL, Michalski R, Radtke JP, Albers P, Antoch G, Schimmöller L. Influence of benign prostatic hyperplasia patterns detected with MRI on the clinical outcome after prostatic artery embolization. CVIR Endovasc 2023; 6:9. [PMID: 36859572 PMCID: PMC9978045 DOI: 10.1186/s42155-023-00357-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 02/14/2023] [Indexed: 03/03/2023] Open
Abstract
BACKGROUND To investigate the influence of benign prostatic hyperplasia (BPH) patterns detected with MRI on clinical outcomes after prostatic artery embolization (PAE). MATERIALS & METHODS This retrospective study included 71 consecutive patients with lower urinary tract symptoms (LUTS), who underwent magnetic resonance imaging (MRI) of the prostate followed by PAE at a single centre. MRI scans were evaluated and BPH patterns were determined according to Wasserman type and a modified BPH classification. Additionally, scans were evaluated regarding the presence of adenomatous-dominant benign prostatic hyperplasia (AdBPH). LUTS were assessed using the International Prostate Symptom Score (IPSS) and urinary flow rate (Qmax). Follow-up examination included MRI and clinical outcome. RESULTS For clinical outcome at follow-up, IPSS showed median reduction of 54% (IQR 41-75%) and Qmax improved by 4.1 ml/s. We noted significant reduction in volume, intraprostatic protrusion, and prostatic urethral angle in our collective (p < 0.01). Median volume reduction was 25% (IQR 15%-34%). Bilateral embolization was a significant predictor for volume reduction at follow-up. Multiple linear regression analysis showed significant effect of high initial volume on reduction in IPSS after treatment (p < 0.01). Presence of AdBPH was significantly associated with both, volume loss and clinical improvement in terms of IPSS reduction (p < 0.01). Neither BPH pattern based on the Wassermann type nor modified BPH classification were significantly related with postinterventional IPSS and volume loss. CONCLUSIONS Men benefit from PAE regardless the macroscopic BPH MRI pattern. Preinterventional prostate volume and presence of AdBPH on MRI should be considered for outcome prognosis after PAE.
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Affiliation(s)
- Matthias Boschheidgen
- Medical Faculty, Department of Diagnostic and Interventional Radiology, University Dusseldorf, Moorenstr. 5, Dusseldorf, D-40225, Germany.
| | - Rouvier Al-Monajjed
- grid.411327.20000 0001 2176 9917Medical Faculty, Department of Urology, University Dusseldorf, Moorenstr. 5, Dusseldorf, D-40225 Germany
| | - Peter Minko
- grid.411327.20000 0001 2176 9917Medical Faculty, Department of Diagnostic and Interventional Radiology, University Dusseldorf, Moorenstr. 5, Dusseldorf, D-40225 Germany
| | - Kai Jannusch
- grid.411327.20000 0001 2176 9917Medical Faculty, Department of Diagnostic and Interventional Radiology, University Dusseldorf, Moorenstr. 5, Dusseldorf, D-40225 Germany
| | - Tim Ullrich
- grid.411327.20000 0001 2176 9917Medical Faculty, Department of Diagnostic and Interventional Radiology, University Dusseldorf, Moorenstr. 5, Dusseldorf, D-40225 Germany
| | - Karl Ludger Radke
- grid.411327.20000 0001 2176 9917Medical Faculty, Department of Diagnostic and Interventional Radiology, University Dusseldorf, Moorenstr. 5, Dusseldorf, D-40225 Germany
| | - Rene Michalski
- grid.411327.20000 0001 2176 9917Medical Faculty, Department of Urology, University Dusseldorf, Moorenstr. 5, Dusseldorf, D-40225 Germany
| | - Jan Philipp Radtke
- grid.411327.20000 0001 2176 9917Medical Faculty, Department of Urology, University Dusseldorf, Moorenstr. 5, Dusseldorf, D-40225 Germany
| | - Peter Albers
- grid.411327.20000 0001 2176 9917Medical Faculty, Department of Urology, University Dusseldorf, Moorenstr. 5, Dusseldorf, D-40225 Germany
| | - Gerald Antoch
- grid.411327.20000 0001 2176 9917Medical Faculty, Department of Diagnostic and Interventional Radiology, University Dusseldorf, Moorenstr. 5, Dusseldorf, D-40225 Germany
| | - Lars Schimmöller
- grid.411327.20000 0001 2176 9917Medical Faculty, Department of Diagnostic and Interventional Radiology, University Dusseldorf, Moorenstr. 5, Dusseldorf, D-40225 Germany
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21
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Powell T, Rahman S, Staib L, Bhatia S, Ayyagari R. Operator Learning Curve for Prostatic Artery Embolization and Its Impact on Outcomes in 296 Patients. Cardiovasc Intervent Radiol 2023; 46:229-237. [PMID: 36456689 DOI: 10.1007/s00270-022-03321-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 11/16/2022] [Indexed: 12/02/2022]
Abstract
PURPOSE To define operator learning curve inflection points for prostatic artery embolization (PAE) and their impact on technical efficiency, clinical outcomes, and adverse events. MATERIALS AND METHODS Between May 2013 and May 2021, 296 consecutive patients with moderate-to-severe lower urinary tract symptoms, urinary retention, or gross hematuria from benign prostatic hyperplasia underwent PAE by an interventional radiologist without prior PAE-specific experience. Operator learning curves plotted procedure time, fluoroscopy time, contrast volume, and embolic endpoint data against sequential procedure number. Multiple regression analysis evaluated for improvements in these parameters, with segmented linear regression to detect learning curve inflection points. Linear and logistic regression evaluated for learning curve impacts on 6-month clinical outcomes and 90-day adverse events. RESULTS No baseline patient characteristic varied over the series apart from decreasing pre-procedural gland volume (P < 0.01). Multiple regression analysis demonstrated experience-dependent improvements in procedure time, fluoroscopy time, and contrast volume (P < 0.01), with corresponding learning curve inflection points at 76 (P < 0.01), 78 (P < 0.01), and 73 (P = 0.10) procedures. Embolic endpoints did not vary with experience (P > 0.05). Post-procedure reductions in International Prostate Symptom Score (21.5 ± 6.2 to 6.7 ± 4.7), Quality of Life score (4.5 ± 1.2 to 1.3 ± 1.2), post-void residual (190 ± 203 to 97 ± 148 mL), and gland volume (142 ± 97 to 76 ± 47 mL) were substantial (P < 0.01) but did not vary with experience (P > 0.05), nor did adverse event frequency/severity (P > 0.05). CONCLUSION Operator technical efficiency plateaued after 73-78 PAE procedures. Clinical improvements were substantial and adverse event frequency/severity low, and neither varied with experience. Operators without prior PAE-specific experience may perform PAE safely and effectively from the outset. LEVEL OF EVIDENCE Level 2b, Cohort Study.
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Affiliation(s)
- Taylor Powell
- Yale University School of Medicine, New Haven, CT, USA
| | - Saumik Rahman
- Yale University School of Medicine, New Haven, CT, USA
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22
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Prostatic Artery Embolization Using N-Butyl Cyanoacrylate Glue in Patients with Indwelling Catheter. Cardiovasc Intervent Radiol 2023; 46:295-298. [PMID: 36357699 DOI: 10.1007/s00270-022-03315-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 10/31/2022] [Indexed: 11/12/2022]
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23
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Bilhim T. Prostatic Artery Embolization: An Update. Korean J Radiol 2023; 24:313-323. [PMID: 36788767 PMCID: PMC10067687 DOI: 10.3348/kjr.2022.0814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 11/30/2022] [Accepted: 12/07/2022] [Indexed: 01/27/2023] Open
Affiliation(s)
- Tiago Bilhim
- Department of Interventional Radiology, Saint Louis Hospital, Lisbon, Portugal.,Department of Interventional Radiology, Centro Hospitalar Universitário de Lisboa Central (CHULC), Lisbon, Portugal.
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24
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Sciacqua LV, Vanzulli A, Di Meo R, Pellegrino G, Lavorato R, Vitale G, Carrafiello G. Minimally Invasive Treatment in Benign Prostatic Hyperplasia (BPH). Technol Cancer Res Treat 2023; 22:15330338231155000. [PMID: 36794408 PMCID: PMC9936536 DOI: 10.1177/15330338231155000] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023] Open
Abstract
Review efficacy and safety of minimally-invasive treatments for Low Urinary Tract Symptoms (LUTS) in patients affected by Benign Prostate Hyperplasia (BPH). We performed a systematic review of the literature from 1993 to 2022 leveraging original research articles, reviews, and case-studies published in peer-reviewed journals and stored in public repositories. Prostate artery embolization (PAE), transurethral needle ablation (TUNA), transurethral microwave thermotherapy (TUMT), high intensity focused ultrasound (HIFU), laser treatments and Cryoablation are valid and safe alternatives to the gold standard (surgery) in the treatment of LUTS in patients affected by BPH, with fewer undesired effects being reported.
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Affiliation(s)
- L V Sciacqua
- Residency Program in Diagnostic and Interventional Radiology, Università degli Studi di Milano, Milan, Italy
| | - A Vanzulli
- Residency Program in Diagnostic and Interventional Radiology, Università degli Studi di Milano, Milan, Italy
| | - R Di Meo
- Residency Program in Diagnostic and Interventional Radiology, Università degli Studi di Milano, Milan, Italy
| | - G Pellegrino
- Residency Program in Diagnostic and Interventional Radiology, Università degli Studi di Milano, Milan, Italy
| | - R Lavorato
- Researcher at Diagnostic and Interventional Radiology Department, IRCCS Ca' Granda Fondazione Ospedale Maggiore Policlinico, Milan, Italy
| | - G Vitale
- Department of Medical Biotechnology and Translational Medicine, 9304University of Milan, Milan, Italy.,Istituto Auxologico Italiano, IRCCS, Laboratory of Geriatric and Oncologic Neuroendocrinology Research, Milan, Italy
| | - G Carrafiello
- Diagnostic and Interventional Radiology Department, IRCCS Ca' Granda Fondazione Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
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25
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Prostate Artery Embolization: Challenges, Tips, Tricks, and Perspectives. J Pers Med 2022; 13:jpm13010087. [PMID: 36675748 PMCID: PMC9865478 DOI: 10.3390/jpm13010087] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 12/13/2022] [Accepted: 12/27/2022] [Indexed: 12/31/2022] Open
Abstract
Prostatic artery embolization (PAE) consists of blocking the arteries supplying the prostate to treat benign prostate hypertrophia (BPH). Its effectiveness on both urinary symptoms and flowmetric parameters has now been amply demonstrated by around a hundred studies, including several randomized trials. The main advantage of this procedure is the very low rate of urinary and sexual sequelae, including ejaculatory, with an excellent tolerance profile. The arterial anatomy is a key element for the realization of PAE. Its knowledge makes it possible to anticipate obstacles and prevent potential complications related to nontarget embolization. Nontarget embolization can occur with a small intraprostatic shunt or reflux and has no consequences except some local inflammation symptoms that resolve in a couple of days. Nevertheless, some situations with large arterial shunts arising from the prostatic artery must be recognized (accessory rectal, bladder, or pudendal branches), and must imperatively be protected before embolization, at the risk of exposing oneself to otherwise ischemic complications that are more severe, such as bladder necrosis and skin or mucosal necrosis. This article offers a step-by-step review of the various anatomical and technical key points to ensure technical and clinical success, while avoiding the occurrence of adverse events.
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26
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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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27
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Qamhawi Z, Little MW. The State of Evidence in Prostate Artery Embolization. Semin Intervent Radiol 2022; 39:571-576. [PMID: 36561795 PMCID: PMC9767761 DOI: 10.1055/s-0042-1759733] [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
Prostate artery embolization (PAE) has emerged over the past two decades as a minimally invasive, nonsurgical treatment for benign prostatic hypertrophy (BPH). While the majority of evidence for PAE stems from retrospective cohort studies, several seminal randomized controlled trials have been performed comparing short-term outcomes of PAE to transurethral resection of prostate (TURP) and against a sham procedure. Across clinical trials, PAE demonstrates consistent improvement in urological symptoms and quality of life in patients with BPH with low complication rates. When compared to TURP, the results are comparable, but there is a trend for better outcomes in certain clinical parameters with TURP. PAE is a suitable option for patients who are not surgical candidates, prefer nonsurgical treatment with an earlier return to routine activities, and wish to better preserve sexual function.
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Affiliation(s)
- Zahi Qamhawi
- University Department of Radiology, Royal Berkshire Hospital, Reading, United Kingdom
| | - Mark W. Little
- University Department of Radiology, Royal Berkshire Hospital, Reading, United Kingdom
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28
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Bilhim T. Long-Term PAE Results: What Do We Know. Semin Intervent Radiol 2022; 39:577-580. [PMID: 36561801 PMCID: PMC9767787 DOI: 10.1055/s-0042-1759732] [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
Prostatic artery embolization (PAE) is a minimally invasive technique with proven safety and efficacy to treat lower urinary tract symptoms (LUTS) due to benign prostatic obstruction (BPO) or benign prostatic hyperplasia (BPH). In this review, we discuss the required level of evidence to implement and adopt treatment options for patients with LUTS due to BPO/BPH. Focus is given on the long-term (>3 years) data after PAE with reported outcomes including cohort sizes, follow-up times, reintervention rates (repeat PAE and prostatectomy), need for LUTS/BPO medical therapy, and improvements in International Prostate Symptom Score/quality of life score, peak flow rate (Qmax), postvoid residual, prostate volume, and prostate-specific antigen. The durability of treatment effects after PAE and need for prostatic reinterventions need to be taken into consideration when discussing treatment options with patients and referring colleagues from other medical specialties. Developments in medical devices used for PAE have allowed for a continuous drop in unilateral PAE rates over the last 12 years and will probably play a role in optimizing technical and thus clinical outcomes for patients with LUTS due to BPH/BPO.
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Affiliation(s)
- Tiago Bilhim
- Saint Louis Hospital, Centro Hospitalar Universitário de Lisboa Central (CHULC) Lisbon, Portugal
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29
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Xu ZW, Zhou CG, Tian W, Shi HB, Liu S. Long-Term Efficacy and Recurrence Prediction of Prostatic Artery Embolization for Lower Urinary Tract Symptoms Secondary to Benign Prostatic Hyperplasia. Cardiovasc Intervent Radiol 2022; 45:1801-1809. [PMID: 36131147 DOI: 10.1007/s00270-022-03272-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Accepted: 08/27/2022] [Indexed: 11/02/2022]
Abstract
PURPOSE To explore the efficacy of prostatic artery embolization (PAE) for lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH) during long-term follow-up and analyze predictors related to LUTS recurrence. METHODS This was a single-center retrospective study involving 125 BPH patients with LUTS who underwent PAE from February 2014 to February 2020. The median follow-up was 36 months. Clinical success was defined as reductions in the International Prostate Symptom Score (IPSS) and quality of life (QoL) score and no need for any other treatment for LUTS; otherwise, it was regarded as a clinical failure. Recurrence was defined as a clinical failure that occurred after an initial success. Cumulative clinical success rates, recurrence rates and re-intervention rates were evaluated. Friedman test was performed to compare differences in IPSS, QoL and prostatic volume (PV) among baseline and follow-up times. Predictors for LUTS recurrence were analyzed with the univariate and multivariate Cox regression model. RESULTS Technical success (bilateral PAE) rate was 92.8% (116/125). Significant differences in IPSS, QoL and PV were observed between baseline and follow-up time points (P < 0.001). The cumulative clinical success rates at 2, 3, 4 and 5 years were 82.4%, 65.5%, 52.4% and 37.4%. The cumulative recurrence rates and re-intervention rates at 1, 2 and 5 years were 6.8%, 12.7%, 60.4% and 5.9%, 10.2%, 50.8%, respectively. Unilateral PAE was an significant predictor of recurrence (P < 0.05). CONCLUSIONS PAE is an effective treatment option for LUTS. Unilateral PAE is a significant independent predictor of LUTS recurrence.
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Affiliation(s)
- Zhong-Wei Xu
- Department of Interventional Radiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Gulou District, Nanjing, 210029, China
| | - Chun-Gao Zhou
- Department of Interventional Radiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Gulou District, Nanjing, 210029, China
| | - Wei Tian
- Department of Interventional Radiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Gulou District, Nanjing, 210029, China
| | - Hai-Bin Shi
- Department of Interventional Radiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Gulou District, Nanjing, 210029, China
| | - Sheng Liu
- Department of Interventional Radiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Gulou District, Nanjing, 210029, China.
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30
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Prostatic Artery Embolization for the Treatment of Benign Prostatic Hyperplasia: To Infinity and Beyond. Cardiovasc Intervent Radiol 2022; 45:1337-1338. [PMID: 35948804 DOI: 10.1007/s00270-022-03249-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 08/04/2022] [Indexed: 11/02/2022]
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