Prostatic Artery Embolization Using 100-300-μm Trisacryl Gelatin Microspheres to Treat Lower Urinary Tract Symptoms Attributable to BPH - Beyond the Abstract

The American Urological Association guideline for the procedural treatment of symptomatic BPH is written to address index patients who are appropriate candidates for any one of a list of transurethral, open, or laparoscopic surgical procedures to address prostatic bladder outlet obstruction. However, little is written to address non-index BPH patients, those with glands too large or comorbidities too severe for standard surgical procedures. These patients typically have few acceptable treatment options. Prostatic artery embolization (PAE) is an outpatient procedure, performed by interventional radiologists through a tiny percutaneous access using mild IV sedation, that provides real value by offering these patients a safe and effective treatment alternative.

Following our recent report published in the journal Urology on PAE to treat patients with gross prostatic hematuria or urinary retention, our current study reports results for PAE in patients with lower urinary tract symptoms (LUTS) attributed to BPH. These were elderly patients (age = 71.8 ± 9.3 years) with severe symptoms (IPSS = 22.4 ± 5.6, QoL = 4.4 ± 0.9, post-void residual = 172 ± 144 mL), comorbidities too severe for simple prostatectomy (CCI = 3.5 ± 1.7), and glands too large for transurethral procedures (volume = 174 ± 110 mL). Additionally, the HOLEP procedure was not regionally available. As detailed in our report, these patients had excellent results with stability out to 24 months, regardless of median lobe enlargement or gland size, and with very low procedure-related morbidity.

These results contribute to a growing body of evidence already reported in the scientific literature supporting the efficacy and safety of PAE for treatment of BPH-related problems in non-index patients. Indeed, the PAE procedure is now widely accepted and practiced in Europe. As one of the select centers in the USA that have been able to perform hundreds of these procedures thanks to a fruitful collaboration with numerous urologists in our region, we hope that our results will promote broader awareness and utilization of the PAE procedure throughout the country and beyond.

Written by: Raj Ayyagari, Taylor Powell, Lawrence Staib, Julius Chapiro, Anusha Raja, Shivank Bhatia, Toby Chai, Steven Schoenberger, Ralph Devito

Yale University School of Medicine, New Haven, CT., Yale University School of Medicine, New Haven, CT., University of Miami School of Medicine, Miami, Florida., Hartford Healthcare, Hartford, Connecticut.

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