Prostatic Artery Embolization as an Alternative to Indwelling Bladder Catheterization to Manage Benign Prostatic Hyperplasia in Poor Surgical Candidates

To prospectively assess discontinuation of indwelling bladder catheterization (IBC) and relief of lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH) following prostate artery embolization (PAE) in poor surgical candidates.

Patients ineligible for surgical intervention were offered PAE after at least 1 month of IBC for management of urinary retention secondary to BPH; exclusion criteria for PAE included eligibility for surgery, active bladder cancer or known prostate cancer. Embolization technical and clinical success were defined as bilateral prostate embolization and removal of IBC, respectively. Patients were followed for at least 6 months and evaluated for International Prostate Symptom Score, quality of life, prostate size and uroflowmetric parameters.

A total of 43 patients were enrolled; bilateral embolization was performed in 33 (76.7%), unilateral embolization was performed in 8 (18.6%), and two patients could not be embolized due to tortuous and atherosclerotic pelvic vasculature (4.7%). Among the patients who were embolized, mean prostate size decreased from 75.6 ± 33.2 to 63.0 ± 23.2 g (sign rank p = 0.0001, mean reduction of 19.6 ± 17.3%), and IBC removal was achieved in 33 patients (80.5%). Clavien II complications were reported in nine patients (21.9%) and included urinary tract infection (three patients, 7.3%) and recurrent acute urinary retention (six patients, 14.6%). Nine patients (22.0%) experienced post-embolization syndrome.

PAE is a safe and feasible for the relief of LUTS and IBC in highly comorbid patients without surgical treatment options.

Cardiovascular and interventional radiology. 2017 Jan 27 [Epub ahead of print]

Antonio Rampoldi, Fabiane Barbosa, Silvia Secco, Carmelo Migliorisi, Antonio Galfano, Giovanni Prestini, Sardis Honoria Harward, Dario Di Trapani, Pietro Maria Brambillasca, Vercelli Ruggero, Marco Solcia, Francisco Cesar Carnevale, Aldo Massimo Bocciardi

Department of Interventional Radiology, Ospedale Niguarda Ca' Granda, Piazza Ospedale Maggiore, 3, 20100, Milan, Italy., Department of Interventional Radiology, Ospedale Niguarda Ca' Granda, Piazza Ospedale Maggiore, 3, 20100, Milan, Italy. ., Department of Urology, Ospedale Niguarda Ca' Granda, Piazza Ospedale Maggiore, 3, 20100, Milan, Italy., The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth-Hitchcock Medical Center, 1 Medical Center Drive, Lebanon, NH, 03756, USA., Department of Interventional Radiology, University of Sao Paulo Medical School, Av. Dr. Enéas de Carvalho Aguiar, 255, Sao Paulo, SP, 05403-001, Brazil.

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