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Wise R, Fu H, Tapping CR. Prostate volume: does it predict patient outcomes following prostate artery embolisation? A retrospective cohort study. CVIR Endovasc 2024; 7:51. [PMID: 38935182 PMCID: PMC11211285 DOI: 10.1186/s42155-024-00464-4] [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: 03/21/2024] [Accepted: 06/11/2024] [Indexed: 06/28/2024] Open
Abstract
Prostate artery embolisation (PAE) is a minimally invasive procedure commonly performed to treat lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia. International Prostate Symptom Score (IPSS) is a validated patient questionnaire quantifying LUTS and is used for patient selection for PAE, but it is largely subjective. Prostate volume is an easily estimated objective parameter across multiple imaging modalities. No strict threshold of prostate volume is established as a selection criterion for PAE, but it is generally accepted that prostate volume should be over 40 to 50 mL.We looked at a sample of 65 cases performed at a large teaching hospital between 2017 and 2019 with a minimum of four years follow up. Embospheres between 100 to 500 microns were injected into the prostatic arteries bilaterally (if technically feasible). A 'bullet shape' model was used to estimate prostatic volume from initial CT. N = 13 had an estimated volume < 51 mL (range 31-50 mL). IPSS before and at 3 months post-procedure were collected.80% of patients indicated a beneficial response to PAE (IPSS improvement > 5). 23% of patients required further PAE procedure or surgery. No major complications were recorded. The mean change in IPSS under 51 mL compared to over 51 mL cohort was 10.2 versus 11 (standard deviation 7.5 versus 7.3) (p = 0.44, 2 tailed Student's T-test).There was no statistically significant difference in the IPSS improvement or outcome of small volume prostates under 51 mL compared to large volume. Our results suggest that prostate volume should not be used to exclude patients for PAE.
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Affiliation(s)
- Robert Wise
- Department of Radiology, Oxford University Hospitals NHS Foundation Trust John Radcliffe Hospital, Headley Way, Headington, Oxford, OX3 9DU, United Kingdom.
| | - Howell Fu
- Department of Radiology, Oxford University Hospitals NHS Foundation Trust John Radcliffe Hospital, Headley Way, Headington, Oxford, OX3 9DU, United Kingdom
| | - Charles Ross Tapping
- Department of Radiology, Oxford University Hospitals NHS Foundation Trust John Radcliffe Hospital, Headley Way, Headington, Oxford, OX3 9DU, United Kingdom
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Moschouris H, Tsetsou I, Kaniaris A, Stamatiou K. Transradial Prostatic Artery Embolization as a Salvage Procedure in a Patient With Severe Deformities and Refractory Hematuria of Prostatic Origin. Cureus 2024; 16:e59894. [PMID: 38854172 PMCID: PMC11160449 DOI: 10.7759/cureus.59894] [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] [Accepted: 05/05/2024] [Indexed: 06/11/2024] Open
Abstract
Benign prostatic hyperplasia is a common condition causing urinary symptoms in older men. It can sometimes lead to hematuria of prostatic origin, due to increased vascularity of the enlarged gland. If this type of hematuria is severe and refractory to conservative measures, it can be life-threatening. Prostatic artery embolization (PAE) serves as a minimally invasive alternative to traditional surgical interventions, particularly in patients with comorbidities and contraindications to surgery. We present a case of a 79-year-old male with refractory hematuria of prostatic origin (RHPO), multiple comorbidities, and significant deformities of the left upper and both lower limbs. The patient was treated with PAE via the right radial artery, a less common approach in interventional radiology. The procedure was successful and led to a complete resolution of hematuria, with no complications. This report highlights the importance of adapting treatment for complex patients and shows that PAE can be safe and effective in such cases.
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Affiliation(s)
| | - Ilianna Tsetsou
- Imaging and Interventional Radiology, "Sotiria" General and Chest Diseases Hospital of Athens, Athens, GRC
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Altman R, Ferreira R, Barragan C, Bhojani N, Lajkosz K, Zorn KC, Chughtai B, Annamalai G, Elterman DS. Comparing prostatic artery embolization to surgical and minimally invasive procedures for the treatment of benign prostatic hyperplasia: a systematic review and meta-analysis. BMC Urol 2024; 24:22. [PMID: 38281906 PMCID: PMC10822184 DOI: 10.1186/s12894-023-01397-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Accepted: 12/28/2023] [Indexed: 01/30/2024] Open
Abstract
BACKGROUND To summarize current evidence to report a comparative systematic review and meta-analysis of prostatic artery embolization (PAE) with transurethral resection of the prostate (TURP) and open simple prostatectomy (OSP) for the treatment of benign prostatic hyperplasia (BPH). METHODS A systematic literature search was performed to identify studies published from inception until August 2021. The search terms used were (prostate embolization OR prostatic embolization) AND (prostatic hyperplasia OR prostatic obstruction) as well as the abbreviations of PAE and BPH. Risk of bias was assessed using the Cochrane Risk of Bias tool for randomized controlled trials (RCTs) and the Risk of Bias in Non-randomized Studies-of Interventions (ROBINS-I) tool for observational studies. Random-effects meta-analysis was performed using Revman 5.4. RESULTS Seven studies were included with 810 patients: five RCTs and one observational study compared PAE with TURP, and one observational study compared PAE with OSP. The included studies had considerable risk of bias concerns. TURP and OSP were associated with more statistically significant improvements in urodynamic measures and BPH symptoms compared to PAE. However, PAE seems to significantly improve erectile dysfunction compared to OSP and improve other outcome measures compared to TURP, although not significantly. PAE appeared to reduce adverse events and report more minor complications compared with TURP and OSP, but it is unclear whether PAE is more effective in the long-term. CONCLUSION PAE is an emerging treatment option for patients with symptomatic BPH who cannot undergo surgery or have undergone failed medical therapy. Overall, PAE groups reported fewer adverse events. Future ongoing and longer-term studies are needed to provide better insight into the benefit of PAE compared to other treatment options.
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Affiliation(s)
- Rachel Altman
- Division of Urology, Department of Surgery, University Health Network, Toronto, ON, Canada
| | - Roseanne Ferreira
- Division of Urology, Department of Surgery, University Health Network, Toronto, ON, Canada
| | - Camilo Barragan
- Department of Vascular and Interventional Radiology, University Health Network, Mount Sinai Hospital, Toronto, ON, Canada
| | - Naeem Bhojani
- Department of Surgery, University of Montreal Hospital Center, Montreal, QC, Canada
| | - Katherine Lajkosz
- Department of Biostatistics, University Health Network/Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Kevin C Zorn
- Department of Surgery, University of Montreal Hospital Center, Montreal, QC, Canada
| | - Bilal Chughtai
- Department of Urology, Weill Cornell Medical College, New York, NY, USA
| | - Ganesan Annamalai
- Department of Vascular and Interventional Radiology, University Health Network, Mount Sinai Hospital, Toronto, ON, Canada
- Department of Vascular and Interventional Radiology, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Dean S Elterman
- Division of Urology, Department of Surgery, University Health Network, Toronto, ON, Canada.
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Kaltsas A, Kratiras Z, Zachariou A, Dimitriadis F, Sofikitis N, Chrisofos M. Evaluating the Impact of Benign Prostatic Hyperplasia Surgical Treatments on Sexual Health. Biomedicines 2024; 12:110. [PMID: 38255215 PMCID: PMC10813562 DOI: 10.3390/biomedicines12010110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 12/30/2023] [Accepted: 01/03/2024] [Indexed: 01/24/2024] Open
Abstract
Benign prostatic hyperplasia (BPH), a prevalent condition in older men, is often managed through various surgical interventions. This narrative review aims to explore the impact of these surgical treatments on sexual function, a critical aspect of patient quality of life often overlooked in BPH management. The methodology encompassed a thorough review of contemporary surgical techniques for BPH, including prostate resection, enucleation, vaporization, and minimally invasive therapies such as UroLift, Rezum, and Aquablation. Additionally, the focus was on patient-centered outcomes, with a special emphasis on sexual health following surgery. Findings reveal that, while surgical interventions effectively alleviate BPH symptoms, they often have significant repercussions in sexual function, including erectile and ejaculatory dysfunction. However, emerging techniques demonstrate potential in preserving sexual function, underscoring the need for patient-centric treatment approaches. The study highlights the complex interplay between BPH surgery and sexual health, with minimally invasive treatments showing promise in balancing symptom relief and sexual function preservation. In conclusion, the study advocates for an integrated, interdisciplinary approach to BPH treatment, emphasizing the importance of considering sexual health in therapeutic decision-making. This narrative review suggests a paradigm shift towards minimally invasive techniques could optimize patient outcomes, marrying symptom relief with quality-of-life considerations. The need for further research in this domain is evident, particularly in understanding long-term sexual health outcomes following different surgical interventions for BPH.
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Affiliation(s)
- Aris Kaltsas
- Third Department of Urology, Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece; (A.K.); (Z.K.)
| | - Zisis Kratiras
- Third Department of Urology, Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece; (A.K.); (Z.K.)
| | - Athanasios Zachariou
- Department of Urology, Faculty of Medicine, School of Health Sciences, University of Ioannina, 45110 Ioannina, Greece; (A.Z.); (N.S.)
| | - Fotios Dimitriadis
- Department of Urology, Faculty of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece;
| | - Nikolaos Sofikitis
- Department of Urology, Faculty of Medicine, School of Health Sciences, University of Ioannina, 45110 Ioannina, Greece; (A.Z.); (N.S.)
| | - Michael Chrisofos
- Third Department of Urology, Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece; (A.K.); (Z.K.)
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Gharbieh S, Reeves F, Challacombe B. The prostatic middle lobe: clinical significance, presentation and management. Nat Rev Urol 2023; 20:645-653. [PMID: 37188789 DOI: 10.1038/s41585-023-00774-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/14/2023] [Indexed: 05/17/2023]
Abstract
The role of the prostatic middle lobe in the presentation and management of benign prostatic hyperplasia (BPH) is under-appreciated. Middle lobe enlargement is associated with intravesical prostatic protrusion (IPP), which causes a unique type of bladder outlet obstruction (BOO) via a 'ball-valve' mechanism. IPP is a reliable predictor of BOO and the strongest independent factor for failure of medical therapy necessitating conversion to surgical intervention. Men with middle lobe enlargement tend to exhibit mixed symptoms of both the storage and the voiding types, but symptomatology will vary depending on the degree of IPP present. Initial assessments such as uroflowmetry and post-void residual volumes are inadequate to detect IPP and could confound the clinical picture. Radiological evaluation of prostate morphology is key to assessment as it provides important prognostic information and can help with operative planning. Treatment strategies employed for BPH should consider the shape and morphology of prostate adenomata, specifically the presence of middle lobe enlargement and the degree of associated IPP.
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Jankauskas T, Buržinskis E, Kaupas RS, Basevičius A, Jievaltas M. Prostatic Artery Embolization as a Treatment Option for Symptomatic Benign Prostatic Hyperplasia: Results from the Prospective Follow-Up Study in Lithuania. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1871. [PMID: 37893589 PMCID: PMC10608601 DOI: 10.3390/medicina59101871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/16/2023] [Accepted: 10/19/2023] [Indexed: 10/29/2023]
Abstract
Background: The endovascular treatment of symptomatic benign prostate hypertrophy (BPH) by prostatic artery embolization (PAE) is one of the new treatments proposed. PAE is a minimally invasive alternative that has been shown to successfully treat lower urinary tract symptoms in BPH patients by causing infarction and necrosis of hyperplastic adenomatous tissue, which decompresses urethral impingement and improves obstructive symptoms. The aim of this study was to evaluate the effectiveness and efficacy of PAE in relieving symptoms in patients with symptomatic BPH. Materials and Methods: The material for the study was collected from 2019 to 2022. A total of 70 men with BPH and PAE were studied. Patients underwent an urological examination to measure the International Prostate Symptom Score (IPSS), Quality of Life score (QoL), International Index of Erectile Function short form (IIEF-5), uroflowmetry with Qmax, prostatic volume (PV), and post-void residual volume (PVR) measurements. Statistical analysis for dependent samples was applied. Measured parameters at 2 months and 6 months follow-up were compared to baseline. Results: At baseline, the age of the male (N = 70) subjects was 74 ± 9.6 years with a median of 73.8, but fluctuated from 53 to 90 years. The mean of PV was almost 111 mL and the Qmax was close to 7.7 mL/s. The average PVR was 107.6 mL. The IPSS score mean was 21.3 points and the QoL score was 4.53 points. The IIEF-5 questionnaire score was almost 1.8 points, which shows severe erectile dysfunction. The mean value of the PSA level was 5.8 ng/mL. After 2 and 6 months of PAE, all indicators and scores except erectile function significantly improved. Conclusions: The outcomes of our study show promising results for patients with benign prostatic hyperplasia after PAE. The main prostate-related parameters (PV, Qmax, PVR, IPSS) improved significantly 6 months after embolization.
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Affiliation(s)
- Tautvydas Jankauskas
- Radiology Clinic, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania
| | - Edgaras Buržinskis
- Surgery Clinic, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania
| | - Rytis Stasys Kaupas
- Radiology Clinic, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania
| | - Algidas Basevičius
- Radiology Clinic, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania
| | - Mindaugas Jievaltas
- Urology Clinic, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania
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Cornu JN, Zantek P, Burtt G, Martin C, Martin A, Springate C, Chughtai B. Minimally Invasive Treatments for Benign Prostatic Obstruction: A Systematic Review and Network Meta-analysis. Eur Urol 2023; 83:534-547. [PMID: 36964042 DOI: 10.1016/j.eururo.2023.02.028] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 02/28/2023] [Accepted: 02/28/2023] [Indexed: 03/26/2023]
Abstract
CONTEXT Minimally invasive surgical therapies for male lower urinary tract symptoms secondary to benign prostatic obstruction were developed to be safer and more tolerable than standard ablative techniques. These treatments have not been compared with each other in a randomised fashion, and for some treatments, there are no trials against a reference technique. OBJECTIVE To compare the efficacy, safety, and tolerability of water vapour thermal therapy (WVTT), prostatic urethral lift (PUL), prostatic arterial embolisation (PAE), temporary implantable nitinol device (iTIND), transurethral microwave thermotherapy (TUMT), and transurethral resection of the prostate (TURP). EVIDENCE ACQUISITION A systematic search of MEDLINE/PubMed, Embase, Cochrane Library, and grey literature for randomised controlled trials was performed. Trials meeting the selection criteria were assessed for the risk of bias using the Cochrane RoB2 tool. Treatments were compared, using a network meta-analysis, in terms of outcomes including symptom score, quality of life, maximum urinary flow rate, postvoid residual urine, International Index of Erectile Function (IIEF-5), and scales from the Male Sexual Health Questionnaire. EVIDENCE SYNTHESIS The search identified 63 trials. Symptoms and quality of life for PAE, PUL, and WVTT appeared similar to those for TURP, whereas TURP was found to have the most clinically significant improvement in flow rate. TUMT was less efficacious than TURP but provided similar results on quality of life. Comparisons of ejaculatory function favoured WVTT and PUL compared with TURP. The relative efficacy of iTIND was less clear because of the risk of bias in the respective trial. CONCLUSIONS PAE, PUL, and WVTT appear favourable from a risk-benefit perspective despite probably having less efficacy than TURP for objective outcomes. These findings warrant confirmation through long-term randomised controlled trials. PATIENT SUMMARY This paper has summarised the evidence from 63 clinical trials on minimally invasive surgical therapies for men with symptoms of an enlarged prostate, including water vapour thermal therapy (WVTT), prostatic urethral lift (PUL), prostatic arterial embolisation (PAE), temporary implantable nitinol device, and transurethral microwave thermotherapy (TUMT). Improvement in symptoms for each of PAE, PUL, TUMT, and WVTT in short-term follow-up was similar to that for the standard surgical treatment, although standard surgery appeared to provide the greatest increase in urine flow. Men who had WVTT or PUL were less likely to have problems with sexual function than those who had standard surgery.
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Affiliation(s)
- Jean-Nicolas Cornu
- Department of Urology, Charles Nicolle University Hospital, Rouen Cedex, France.
| | | | | | | | | | | | - Bilal Chughtai
- Department of Urology, Weill Cornell Medical College, New York, NY, USA
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Inflammatory Complications of Prostatic Artery Embolization: an Up-to-Date Review. CURRENT BLADDER DYSFUNCTION REPORTS 2023. [DOI: 10.1007/s11884-023-00687-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
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Tonyali S, Miernik A. Prostatic artery embolization must be considered as a valid treatment option of benign prostatic hyperplasia particularly in patients having serious comorbidities. World J Urol 2023; 41:1205-1206. [PMID: 36764941 DOI: 10.1007/s00345-023-04315-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 01/23/2023] [Indexed: 02/12/2023] Open
Affiliation(s)
- Senol Tonyali
- Department of Urology, Istanbul University Istanbul School of Medicine, Istanbul, Turkey. .,Department of Urology, Faculty of Medicine, University of Freiburg Medical Center, Hugstetter Str. 55, 79106, Freiburg, Germany.
| | - Arkadiusz Miernik
- Department of Urology, Faculty of Medicine, University of Freiburg Medical Center, Hugstetter Str. 55, 79106, Freiburg, Germany
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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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Saghafian Larijani R, Shabani Ravari N, Goodarzi N, Akhlaghpour S, Saghafian Larijani S, Rouini MR, Dinarvand R. Current status of transarterial chemoembolization (TACE) agents in hepatocellular carcinoma treatment. J Drug Deliv Sci Technol 2022. [DOI: 10.1016/j.jddst.2022.103905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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