The standard management of benign prostatic hyperplasia (BPH) is based on the overall health of the patient, on the severity of the lower urinary tract symptoms (LUTS), and on quality-of-life (QoL) considerations. Voiding difficulties attributable to BPH can be quantified with the American Urological Association Symptom Index score (AUA-SI) or International Prostate Symptom Score (IPSS). Various medications can decrease the severity of voiding symptoms secondary to BPH. Impotence, decreased libido, and ejaculatory disorders are known side effects.
The AUA guidelines indicate that patients with mild LUTS secondary to BPH (AUA-SI score < 8) and patients with moderate or severe symptoms who are not bothered by their LUTS should be managed using a strategy of watchful waiting. If the patient elects interventional therapy and there is sufficient evidence of obstruction, the patient and urologist should discuss the benefits and risks of the various interventions.
Transurethral resection of the prostate (TURP) is the most common interventional treatment, but it can be associated with bleeding, erectile dysfunction, and ejaculatory disorders in up to 10 to 65% of patients. The high prevalence rate of BPH has a tremendous impact on the health and quality of life of men. Increasingly, BPH therapy trends are moving away from the gold standard operation of TURP and toward less invasive pharmacological options and minimally invasive procedures provided in an outpatient setting.
Prostatic artery embolization (PAE) is a new BPH treatment under clinical investigation. PAE is a minimally invasive procedure that blocks the blood flow to the prostate, causing shrinkage of the gland. PAE is performed under local anesthesia as an outpatient procedure. A team of interventional radiologists, diagnostic radiologists, and urologists at the University of Sao Paulo Medical School are pioneers of the procedure, which has been widely reported since 2008. The multi-disciplinary team is encouraged by the data demonstrating PAE is a safe and effective minimally invasive treatment for patients with LUTS.
Francisco Cesar Carnevale, Alberto A Antunes, Joaquim M da Motta-Leal-Filho, Ronaldo H Baroni, Antonio SZ Marcelino, Luciana MO Cerri, Giovanni G Cerri, Miguel Srougi
Submitted March 29, 2012 - Accepted for Publication August 3, 2012
KEYWORDS: Benign prostate enlargement, benign prostatic hyperplasia, bladder outlet obstruction, transurethral resection of the prostate, prostatic artery embolization, lower urinary tract symptoms
CORRESPONDENCE: Francisco Cesar Carnevale, Chief, Interventional Radiology Section, Radiology Institute, Hospital das Clinicas, University of Sao Paulo Medical School, Rua Teodoro Sampaio, Sao Paulo, Sao Paulo, 05406-000, Brazil ()
CITATION: UroToday Int J. 2012 October;5(5):art 45. http://dx.doi.org/10.3834/uij.1944-5784.2012.10.04
ACRONYMS AND ABBREVIATIONS: BPE: benign prostate enlargement; BPH: benign prostatic hyperplasia; TURP: transurethral resection of the prostate; PAE: prostatic artery embolization; LUTS: lower urinary tract symptoms; PSA: prostate specific antigen; QoL: quality of life; IPSS: International Prostate Symptoms Score; IIEF: International Index of Erectile Function