Prostatic artery embolization in non-index benign prostatic hyperplasia patients: Single center outcomes for urinary retention and gross prostatic hematuria.

To present outcomes for prostatic artery embolization (PAE) to treat urinary retention and gross prostatic hematuria in non-index benign prostatic hyperplasia (BPH) patients.

and Methods: 75 patients undergoing PAE from December 2013 through August 2018 (age=77.

5±8.6, Age-adjusted Charlson comorbidity index=4.6±2.0, prostate volume=224mL±135mL) for retention (n=46) and/or gross prostatic hematuria (n=55) were retrospectively reviewed. 26 patients had both problems. Retention patients (UR, n=46, catheterization=162.4±148.1 days) underwent voiding trials 1-2 months post-PAE, with International Prostate Symptom Score (IPSS), Quality of Life (QoL), and post-void residual (PVR) recorded at 3, 6, 12, 24, 36 months. Pre- and post-PAE hematuria-related visits were compared for gross hematuria patients (GH, n=39), as were transfusion rates for severe hematuria patients requiring bladder irrigation (SH, n=16). 90-day adverse event tabulation used Clavien-Dindo classification.

Three months post-PAE, 33/38(87%) UR patients were catheter-free (IPSS=8.9±5.3, QoL=1.6±1.7, PVR=158mL±207mL). Results were similar at 6 months (catheter-free=26/28(93%), IPSS=6.5±4.4, QoL=1.1±0.9, PVR=149mL±139mL), 12 months (catheter-free=19/20(95%), IPSS=4.7±4.8, QoL=0.6±0.9, PVR=125mL±176mL), 24 months (catheter-free=11/12(92%), IPSS=4.4±3.0, QoL=0.9±0.8, PVR=66mL±68mL), and 36 months (catheter-free=5/6(83%), IPSS=5.8±3.8, QoL=0.8±1.0, PVR=99mL±71mL). 34/37(92%) GH patients remained hematuria-free at 483±137 days, with 22 hematuria-related visits pre-PAE versus none post-PAE. Hematuria resolved <48 hours post-PAE in 14/16(87.5%) SH patients, with 36 blood units transfused pre-PAE, 4 units transfused <48 hours post-PAE, and none thereafter. 13/16(81%) remained hematuria-free at 500±501 days; 2/16(13%) required fulguration; 1/16(6%) developed bladder tumor. There were 2 deaths <30 days post-PAE, and 8(11%) Grade-II urinary infections.

PAE provided safe, effective, and durable treatment for retention and gross hematuria in non-index BPH patients.

Urology. 2019 Nov 14 [Epub ahead of print]

Raj Ayyagari, Taylor Powell, Lawrence Staib, Julius Chapiro, Juan-Carlos Perez-Lozada, Shivank Bhatia, Toby Chai, Steven Schoenberger, Ralph Devito

Yale University School of Medicine, 360 State Street, #3206, New Haven, CT 06511. Electronic address: ., Yale University School of Medicine, 360 State Street, #3206, New Haven, CT 06511. Electronic address: ., Yale University School of Medicine, 360 State Street, #3206, New Haven, CT 06511. Electronic address: ., Yale University School of Medicine, 360 State Street, #3206, New Haven, CT 06511. Electronic address: ., Yale University School of Medicine, 360 State Street, #3206, New Haven, CT 06511. Electronic address: ., University of Miami School of Medicine. Electronic address: ., Yale University School of Medicine, 360 State Street, #3206, New Haven, CT 06511. Electronic address: ., Hartford Healthcare. Electronic address: ., Yale University School of Medicine, 360 State Street, #3206, New Haven, CT 06511. Electronic address: .

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