Prostate Artery Embolization for Lower Urinary Tract Symptoms Secondary to Benign Prostatic Hyperplasia: Results from a Prospective FDA-Approved Investigational Device Exemption Study

To evaluate the safety and efficacy of prostate artery embolization(PAE) for lower urinary tract symptoms(LUTS) attributed to benign prostatic hyperplasia(BPH).

A prospective, single-center, open-label FDA-approved study was conducted to evaluate the safety and efficacy of PAE for LUTS secondary to BPH. We enrolled men ≥45, prostate volume >40g, International Prostate Symptom Score(IPSS)>13, peak flow rate(Qmax)≤12mL/s, and voided volume ≥125mL. Patients were evaluated with questionnaires[IPSS, quality-of-life(QoL), International Index of Erectile Function(IIEF), and Male Sexual Health Questionnaire for Ejaculatory Dysfunction(MSHQ-EjD)] and clinical measures[post-void residual volume(PVR) and Qmax at baseline,1,3, and 12 months after PAE. Baseline and 6-month total prostate(TV) and central gland(CG) volumes were obtained.

45 patients(mean volume:99 cc, range:30-214g) were treated over the course of the 3-year study. At 1 month, there were improvements in IPSS(23.6±6.1 to 12.0±5.9,P<0.0001),QoL (4.8±0.9 to 2.6±1.6,P<0.0001),Qmax(5.8±1.0 to 12.4±6.8,P<0.0001). At 3 months, there were improvements in IPSS(10.2±6.0,P<0.0001), QoL(2.4±1.6,P<0.0001) and Qmax (15.3±12.3,P<0.0001). At 6 months, there were improvements in IPSS(11.0±7.6,P<0.0001) and QoL (2.3±1.7,P<0.0001). At 1 year, there were improvements in IPSS(12.4±8.4,P<0.0001) and QoL(2.6±1.6,P<0.0001). There were reductions in PVRs: baseline 157±45, 1 month 123±47 P=0.057, 3 months 127±114 P=0.34, 6 months 112±116 P=0.002 and 1 year 109±116 P=0.025. Median decreases in TV and CG were 18%(CI:13-27) (p=0.0001) and 27%(CI:20-36)(p=0.0001), respectively. Self-limited adverse events(AEs) included dysuria(n=13), hematuria(n=6), hematospermia(n=2), urinary frequency(n=3) and retention(n=2). No severe AEs, non-target embolization, or adverse effects on erectile function or sexual health.

This prospective clinical trial demonstrates that PAE is safe and efficacious for BPH, with significant improvement in LUTS and reduction in TV and CG volumes.

Urology. 2018 Jul 20 [Epub ahead of print]

Riad Salem, John Hairston, Elias Hohlastos, Ahsun Riaz, Joseph Kallini, Ahmed Gabr, Rehan Ali, Kimberly Jenkins, Jennifer Karp, Kush Desai, Bartley Thornburg, David Casalino, Frank Miller, Matthias Hofer, Nabeel Hamoui, Samdeep Mouli

Department of Radiology, Section of Interventional Radiology, Northwestern University, Chicago IL. Electronic address: ., Department of Urology, Northwestern University, Chicago, IL., Department of Radiology, Section of Interventional Radiology, Northwestern University, Chicago IL., Department of Radiology, Section of Body Imaging, Northwestern University, Chicago IL.

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