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Moschouris H, Tsetsou I, Kaniaris A, Stamatiou K. Transradial Prostatic Artery Embolization as a Salvage Procedure in a Patient With Severe Deformities and Refractory Hematuria of Prostatic Origin. Cureus 2024; 16:e59894. [PMID: 38854172 PMCID: PMC11160449 DOI: 10.7759/cureus.59894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/05/2024] [Indexed: 06/11/2024] Open
Abstract
Benign prostatic hyperplasia is a common condition causing urinary symptoms in older men. It can sometimes lead to hematuria of prostatic origin, due to increased vascularity of the enlarged gland. If this type of hematuria is severe and refractory to conservative measures, it can be life-threatening. Prostatic artery embolization (PAE) serves as a minimally invasive alternative to traditional surgical interventions, particularly in patients with comorbidities and contraindications to surgery. We present a case of a 79-year-old male with refractory hematuria of prostatic origin (RHPO), multiple comorbidities, and significant deformities of the left upper and both lower limbs. The patient was treated with PAE via the right radial artery, a less common approach in interventional radiology. The procedure was successful and led to a complete resolution of hematuria, with no complications. This report highlights the importance of adapting treatment for complex patients and shows that PAE can be safe and effective in such cases.
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Affiliation(s)
| | - Ilianna Tsetsou
- Imaging and Interventional Radiology, "Sotiria" General and Chest Diseases Hospital of Athens, Athens, GRC
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Sapoval M, Thiounn N, Descazeaud A, Déan C, Ruffion A, Pagnoux G, Duarte RC, Robert G, Petitpierre F, Karsenty G, Vidal V, Murez T, Vernhet-Kovacsik H, de la Taille A, Kobeiter H, Mathieu R, Heautot JF, Droupy S, Frandon J, Barry Delongchamps N, Korb-Savoldelli V, Durand-Zaleski I, Pereira H, Chatellier G. Prostatic artery embolisation versus medical treatment in patients with benign prostatic hyperplasia (PARTEM): a randomised, multicentre, open-label, phase 3, superiority trial. THE LANCET REGIONAL HEALTH. EUROPE 2023; 31:100672. [PMID: 37415648 PMCID: PMC10320610 DOI: 10.1016/j.lanepe.2023.100672] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 06/06/2023] [Accepted: 06/07/2023] [Indexed: 07/08/2023]
Abstract
Background Prostatic artery embolisation (PAE) is a minimally invasive treatment of symptomatic benign prostatic hyperplasia (BPH). Our aim was to compare patient's symptoms improvement after PAE and medical treatment. Methods A randomised, open-label, superiority trial was set in 10 French hospitals. Patients with bothersome lower urinary tract symptoms (LUTS) defined by International Prostatic Symptom Score (IPSS) > 11 and quality of life (QoL) > 3, and BPH ≥50 ml resistant to alpha-blocker monotherapy were randomly assigned (1:1) to PAE or Combined Therapy ([CT], oral dutasteride 0.5 mg/tamsulosin hydrochloride 0.4 mg per day). Randomisation was stratified by centre, IPSS and prostate volume with a minimisation procedure. The primary outcome was the 9-month IPSS change. Primary and safety analysis were done according to the intention-to-treat (ITT) principle among patients with an evaluable primary outcome. ClinicalTrials.gov Identifier: NCT02869971. Findings Ninety patients were randomised from September 2016 to February 2020, and 44 and 43 patients assessed for primary endpoint in PAE and CT groups, respectively. The 9-month change of IPSS was -10.0 (95% confidence interval [CI]: -11.8 to -8.3) and -5.7 (95% CI: -7.5 to -3.8) in the PAE and CT groups, respectively. This reduction was significantly greater in the PAE group than in the CT group (-4.4 [95% CI: -6.9 to -1.9], p = 0.0008). The IIEF-15 score change was 8.2 (95% CI: 2.9-13.5) and -2.8 (95% CI: -8.4 to 2.8) in the PAE and CT groups, respectively. No treatment-related AE or hospitalisation was noticed. After 9 months, 5 and 18 patients had invasive prostate re-treatment in the PAE and CT group, respectively. Interpretation In patients with BPH ≥50 ml and bothersome LUTS resistant to alpha-blocker monotherapy, PAE provides more urinary and sexual symptoms benefit than CT up to 24 months. Funding French Ministry of Health and a complementary grant from Merit Medical.
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Affiliation(s)
- Marc Sapoval
- Université de Paris Cité, PARCC - INSERM Unité-970, Paris, France
- Department of Vascular and Oncological Interventional Radiology, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France
| | - Nicolas Thiounn
- Department of Urology, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France
| | - Aurélien Descazeaud
- Centre Hospitalier Universitaire de Limoges, Department of Urology, Limoges, France
| | - Carole Déan
- Department of Vascular and Oncological Interventional Radiology, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France
| | - Alain Ruffion
- Department of Urology, Hospices Civils de Lyon, Hôpital Lyon Sud, Pierre-Bénite, France
- Université Lyon 1, Faculté de médecine Lyon Sud, Equipe 2 - Centre d’Innovation en Cancérologie de Lyon (EA 3738 CICLY), Lyon, France
| | - Gaële Pagnoux
- Department of Uroradiology, Hospices Civils de Lyon, Hôpital Edouard Herriot, Lyon, France
| | - Ricardo Codas Duarte
- Department of Urology and Transplantation, Hospices Civils de Lyon, Hôpital Edouard Herriot, Lyon, France
| | - Grégoire Robert
- Centre Hospitalier Universitaire de Bordeaux, Department of Urology, Université de Bordeaux, Bordeaux, France
| | - Francois Petitpierre
- Centre Hospitalier Universitaire de Bordeaux, Department of Diagnostic and Therapeutic Imaging, Bordeaux, France
| | - Gilles Karsenty
- Department of Urology and Renal Transplantation, Assistance publique-Hôpitaux de Marseille, Hôpital de la Conception, Aix-Marseille Université, Marseille, France
| | - Vincent Vidal
- Centre Hospitalier Universitaire de la Timone, Interventional Radiology Section, Department of Medical Imaging, Assistance publique-Hôpitaux de Marseille, Marseille, France
- Aix-Marseille Université, LiiE, CERIMED, Marseille, France
| | - Thibaut Murez
- Centre Hospitalier Universitaire de Montpellier, Department of Urology and Renal Transplantation, Montpellier, France
| | - Hélène Vernhet-Kovacsik
- Centre Hospitalier Universitaire de Montpellier, Department of Diagnostic and Interventional Radiology, Hôpital Arnaud-de-Villeneuve, Montpellier, France
| | - Alexandre de la Taille
- Department of Urology, Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Henri Mondor, Créteil, France
| | - Hicham Kobeiter
- Department of Diagnostic and Interventional Medical Imaging, Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Henri Mondor, Université Paris Est, Créteil, France
| | - Romain Mathieu
- Centre Hospitalier Universitaire de Rennes, Department of Urology, Rennes, France
| | - Jean-Francois Heautot
- Centre Hospitalier Universitaire de Rennes, Vascular Medicine Unit, Department of Radiology, Hôpital Pontchaillou, Rennes, France
| | - Stéphane Droupy
- Centre Hospitalier Universitaire De Nîmes, Department of Urology and Andrology, Université de Montpellier, Nîmes, France
| | - Julien Frandon
- Centre Hospitalier Universitaire De Nîmes, Department of Medical Imaging, Université de Montpellier, Nîmes, France
- Medical Imaging Group Nîmes, IMAGINE, Nîmes, France
| | - Nicolas Barry Delongchamps
- Université de Paris Cité, Inserm Unit U1151, Paris, France
- Department of Urology, Assistance Publique-Hôpitaux de Paris, Hôpital Cochin, Paris, France
| | - Virginie Korb-Savoldelli
- Department of Pharmacy, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges-Pompidou, Paris, France
- Department of Clinical Pharmacy, Université Paris-Saclay, Faculté de Pharmacie, Chatenay-Malabry, France
| | - Isabelle Durand-Zaleski
- Université de Paris Cité, CRESS, INSERM UMR1153, INRA, Paris, France
- Assistance Publique-Hôpitaux de Paris, Hôpital de l'Hôtel Dieu, Université Paris Est Créteil, URCEco, Paris, France
| | - Helena Pereira
- INSERM, Centre d'investigation Clinique 1418 Épidémiologie Clinique, Paris, France
- Clinical Research Unit, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges-Pompidou, Paris, France
| | - Gilles Chatellier
- INSERM, Centre d'investigation Clinique 1418 Épidémiologie Clinique, Paris, France
- Clinical Research Unit, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges-Pompidou, Paris, France
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