Key Insights from the Study
Improved Surgical Efficiency: Pre-treatment with PAE was associated with shorter operative times during Aquablation, owing to reduced prostate volume and vascularity. This allowed for a more targeted and efficient resection, reducing procedural complexity.
Reduced Adverse Events: Patients undergoing the combination therapy experienced lower rates of intraoperative bleeding and other complications. This outcome highlights the role of PAE in mitigating the risks associated with resective procedures, making it a safer option for higher-risk patients.
Enhanced Patient Selection: Our propensity score analysis demonstrated the value of this approach in patients with larger prostates or significant comorbidities, where single-modality treatments may be suboptimal.
Implications for Clinical Practice
Combination therapy with PAE and Aquablation is particularly promising for higher-risk patients, such as those with significant concerns about bleeding, prolonged catheterization, or poor bladder function. While either therapy could be performed as a monotherapy, each serves a distinct role in addressing patient needs. We place Aquablation in the category of resective procedures, offering precise, robotic-assisted removal of tissue. In contrast, PAE provides a truly minimally invasive, outpatient solution with rapid recovery and minimal disruption to daily life.
In our multidisciplinary practice, we have found that resective procedures are best suited for patients with poorer bladder function, prolonged catheterization, or exceptionally high post-void residuals. These patients often require immediate and robust symptom relief that resective procedures can provide. Conversely, for patients prioritizing outpatient treatment, a faster return to work, or avoiding catheterization and hospitalization, PAE is an excellent option.
Patient selection and shared decision-making are critical. Addressing not only the anatomical and functional needs of the patient but also their preferences for recovery time, hospitalization, and return to daily activities ensures that treatment aligns with their values and goals. This holistic approach enhances patient satisfaction and outcomes, emphasizing the importance of collaborative care in urology and interventional radiology.
Concluding Thoughts
This study underscores the immense potential for collaboration between urology and interventional radiology in managing complex BPH cases. By combining the strengths of minimally invasive embolization with the precision of resective therapies, we can expand treatment options for patients and improve their quality of life. This multidisciplinary synergy is crucial in developing innovative approaches that cater to the diverse needs and preferences of BPH patients.
The future of BPH management lies in embracing a personalized, patient-centered approach, leveraging the complementary skills and expertise of urologists and interventional radiologists. As we continue to explore and refine combination therapies like PAE and Aquablation, fostering collaboration across specialties will be key to advancing care and achieving the best possible outcomes for our patients.
Written by: Sandeep Bagla,1 Inderjit Singh,2 Abin Sajan,3 Antony Sare,4 Alex Pavidapha,1 Tej Mehta,5 John Klein,2 Shawn Marhamati,2 Lori Lerner,6
- Prostate Centers USA, Falls Church, VA, USA.
- Potomac Urology, Alexandria, VA, USA.
- Department of Radiology, Columbia University Irving Medical Center, New York, NY, USA.
- Department of Radiology & Biomedical Imaging, Yale University School of Medicine, New Haven, CT, USA.
- Department of Radiology, Johns Hopkins Hospital, Baltimore, MD, USA.
- Department of Surgery, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA.