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Pilan BF, de Assis AM, Moreira AM, Rodrigues VCDP, Rocha ADD, Carnevale FC. Prostatic Artery Embolization Using Polyethylene Glycol Microspheres: A 1-Year Follow-up Prospective Study Including 30 Patients. J Vasc Interv Radiol 2023; 34:2197-2202. [PMID: 37657501 DOI: 10.1016/j.jvir.2023.08.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 08/12/2023] [Accepted: 08/23/2023] [Indexed: 09/03/2023] Open
Abstract
PURPOSE To evaluate safety and effectiveness of prostatic artery embolization (PAE) using polyethylene glycol (PEG) microspheres in patients with moderate-to-severe benign prostatic hyperplasia (BPH). MATERIALS AND METHODS A single-center, prospective study of 30 patients who underwent PAE from August 2020 to December 2021 using PEG 400-μm microspheres was conducted. Patient evaluation data using International Prostate Symptom Score (IPSS), quality of life (QoL) score, prostate-specific antigen (PSA), peak urinary flow rate (Qmax), postvoid residual volume (PVR), and prostate volume (PV) at baseline and 3 and 12 months after PAE were obtained. RESULTS Bilateral PAE was performed in all patients. One patient had early clinical failure (3.3%) and another presented with lower urinary tract symptoms (LUTSs) recurrence (3.3%) at the 12-month follow-up. Twenty-eight patients (93.3%) experienced significant and durable LUTS improvement. Mean absolute (and relative) improvement at 3 and 12 months were: IPSS, 14.6 points (-69%) for both; QoL, 3.3 points (-70%) and 3.5 points (-74%); Qmax, 6.3 mL/s (+78%) and 8.6 mL/s (+100%); PSA reduction, 1.2 ng/mL (-22%) and 1.0 ng/mL (-15%); PVR reduction, 48 mL (-56%) and 58.2 mL (-49%); PV reduction, 23.4 cm3 (-29%) and 19.6cm3 (-25%); (P < .05 for all). No major adverse events were observed. Minor adverse events included urinary tract infection (4/30, 13.3%), prostatic tissue elimination (3/30, 10%), penile punctiform ulcer (1/30, 3.3%), and urinary retention (1/30, 3.3%). CONCLUSIONS PAE using PEG microspheres was observed to be effective with sustained LUTS improvement at the 12-month follow-up. The incidence of urinary infection and prostatic tissue elimination was higher than previously reported for other embolics.
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Affiliation(s)
- Bruna Ferreira Pilan
- Department of Radiology and Oncology, University of São Paulo Medical School, São Paulo, Brazil.
| | - André Moreira de Assis
- Department of Radiology and Oncology, University of São Paulo Medical School, São Paulo, Brazil
| | - Airton Mota Moreira
- Department of Radiology and Oncology, University of São Paulo Medical School, São Paulo, Brazil
| | | | - Arthur Diego Dias Rocha
- Department of Radiology and Oncology, University of São Paulo Medical School, São Paulo, Brazil
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Goyal P, Salem R, Mouli SK. Controversies in Prostate Artery Embolization: Future Best Practice. Semin Intervent Radiol 2022; 39:562-570. [PMID: 36561793 PMCID: PMC9767779 DOI: 10.1055/s-0042-1759701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Prevalence of lower urinary tract symptoms secondary to benign prostatic hyperplasia is correlated with age. Men seeking treatment options with a low side effect profile often turn to prostate artery embolization (PAE). PAE continues to be refined with advanced tools and optimized techniques. Nonetheless, there exist controversies in terms of best practices for the management of lower urinary track symptoms (LUTS) with PAE. These controversies are essential for medical progress. Herein we suggest best practices moving forward based on currently available data. Given extensive safety data, we recommend PAE be considered alongside medical management and as a precursor to surgery. Given demonstrated efficacy across gland sizes, PAE can be performed in a single session, ideally in a hybrid angio-CT suite, without preoperative cross-sectional imaging. PAE should be initially performed with 300- to 500-μm size particles, and instead consider exploring other particles and sizes for repeat PAE. Finally, PAE can also be considered as first-line option for recurrent disease given the efficacy and excellent safety profile. This article is not meant to purport a dogma, but rather to serve as a guide to the experienced practitioner in challenging his or her own biases when performing PAE.
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Affiliation(s)
- Piyush Goyal
- Section of Interventional Radiology, Department of Radiology, Northwestern Feinberg School of Medicine, Chicago, Illinois
| | - Riad Salem
- Section of Interventional Radiology, Department of Radiology, Northwestern Feinberg School of Medicine, Chicago, Illinois
| | - Samdeep K. Mouli
- Section of Interventional Radiology, Department of Radiology, Northwestern Feinberg School of Medicine, Chicago, Illinois
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Amouyal G, Tournier L, De Margerie-Mellon C, Pachev A, Assouline J, Bouda D, De Bazelaire C, Marques F, Le Strat S, Desgrandchamps F, De Kerviler E. Safety Profile of Ambulatory Prostatic Artery Embolization after a Significant Learning Curve: Update on Adverse Events. J Pers Med 2022; 12:jpm12081261. [PMID: 36013210 PMCID: PMC9409998 DOI: 10.3390/jpm12081261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Revised: 07/18/2022] [Accepted: 07/26/2022] [Indexed: 11/24/2022] Open
Abstract
Background: to report the safety of outpatient prostatic artery embolization (PAE) after a significant learning curve. Methods: a retrospective bi-institutional study was conducted between June 2018 and April 2022 on 311 consecutive patients, with a mean age of 69 years ± 9.8 (47–102), treated by outpatient PAE. Indications included lower urinary tract symptoms, acute urinary retention, and hematuria. When needed, 3D-imaging and/or coil protection of extra-prostatic supplies were performed to avoid non-target embolization. Adverse events were monitored at 1-, 6-, and 12-month follow-ups. Results: bilateral PAE was achieved in 305/311 (98.1%). Mean dose area product/fluoroscopy times were 16,408.3 ± 12,078.9 (2959–81,608) μGy.m2/36.3 ± 1.7 (11–97) minutes. Coil protection was performed on 67/311 (21.5%) patients in 78 vesical, penile, or rectal supplies. Embolization-related adverse events varied between 0 and 2.6%, access-site adverse events between 0 and 18%, and were all minor. There was no major event. Conclusion: outpatient PAE performed after achieving a significant learning curve may lead to a decreased and low rate of adverse events. Experience in arterial anatomy and coil protection may play a role in safety, but the necessity of the latter in some patterns may need confirmation by additional studies in randomized designs.
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Affiliation(s)
- Gregory Amouyal
- Ramsay Santé—Hôpital Privé Geoffroy Saint-Hilaire, 75005 Paris, France; (F.M.); (S.L.S.)
- Radiology Department, Hôpital Saint-Louis, 75010 Paris, France; (L.T.); (C.D.M.-M.); (A.P.); (J.A.); (D.B.); (C.D.B.); (E.D.K.)
- Correspondence: ; Tel.: +33-670132138; Fax: +33-142494126
| | - Louis Tournier
- Radiology Department, Hôpital Saint-Louis, 75010 Paris, France; (L.T.); (C.D.M.-M.); (A.P.); (J.A.); (D.B.); (C.D.B.); (E.D.K.)
- Faculté de Médecine, Université Paris Cité, 75006 Paris, France;
| | - Constance De Margerie-Mellon
- Radiology Department, Hôpital Saint-Louis, 75010 Paris, France; (L.T.); (C.D.M.-M.); (A.P.); (J.A.); (D.B.); (C.D.B.); (E.D.K.)
- Faculté de Médecine, Université Paris Cité, 75006 Paris, France;
| | - Atanas Pachev
- Radiology Department, Hôpital Saint-Louis, 75010 Paris, France; (L.T.); (C.D.M.-M.); (A.P.); (J.A.); (D.B.); (C.D.B.); (E.D.K.)
- Faculté de Médecine, Université Paris Cité, 75006 Paris, France;
| | - Jessica Assouline
- Radiology Department, Hôpital Saint-Louis, 75010 Paris, France; (L.T.); (C.D.M.-M.); (A.P.); (J.A.); (D.B.); (C.D.B.); (E.D.K.)
- Faculté de Médecine, Université Paris Cité, 75006 Paris, France;
| | - Damien Bouda
- Radiology Department, Hôpital Saint-Louis, 75010 Paris, France; (L.T.); (C.D.M.-M.); (A.P.); (J.A.); (D.B.); (C.D.B.); (E.D.K.)
- Faculté de Médecine, Université Paris Cité, 75006 Paris, France;
| | - Cédric De Bazelaire
- Radiology Department, Hôpital Saint-Louis, 75010 Paris, France; (L.T.); (C.D.M.-M.); (A.P.); (J.A.); (D.B.); (C.D.B.); (E.D.K.)
- Faculté de Médecine, Université Paris Cité, 75006 Paris, France;
| | - Florent Marques
- Ramsay Santé—Hôpital Privé Geoffroy Saint-Hilaire, 75005 Paris, France; (F.M.); (S.L.S.)
| | - Solenne Le Strat
- Ramsay Santé—Hôpital Privé Geoffroy Saint-Hilaire, 75005 Paris, France; (F.M.); (S.L.S.)
| | - François Desgrandchamps
- Faculté de Médecine, Université Paris Cité, 75006 Paris, France;
- Urology Department, Hôpital Saint-Louis, 75010 Paris, France
- SRHI/CEA—Institut de Recherche Clinique Saint-Louis, Hôpital Saint-Louis, 75010 Paris, France
| | - Eric De Kerviler
- Radiology Department, Hôpital Saint-Louis, 75010 Paris, France; (L.T.); (C.D.M.-M.); (A.P.); (J.A.); (D.B.); (C.D.B.); (E.D.K.)
- Faculté de Médecine, Université Paris Cité, 75006 Paris, France;
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Moschouris H, Stamatiou K, Spanomanolis N, Bisyri K, Malagari K. Degenerated, Pouch-Shaped, Intermittently Protruding Median Lobe Causing Early Symptomatic Recurrence After Prostatic Artery Embolization. Cardiovasc Intervent Radiol 2022. [PMID: 35835872 DOI: 10.1007/s00270-022-03217-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 06/25/2022] [Indexed: 11/02/2022]
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Patel PM, Osadchiy V, Quirk M, Dunn MD, Donin NM. Devitalized Prostatic Adenoma Causing Bladder Outlet Obstruction: An Unusual Complication After Prostatic Artery Embolization Requiring Salvage Laser Enucleation. Cardiovasc Intervent Radiol 2022. [PMID: 35296932 DOI: 10.1007/s00270-022-03098-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 02/09/2022] [Indexed: 11/02/2022]
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Hakimé A, Tun JK, Haab F, Sarrazin JL, De Baere T, Tselikas L, Kuoch V. Using prostate contrast retention (PCR) as the procedural endpoint in prostatic artery embolization for benign prostatic hyperplasia. Eur Radiol 2021; 31:9150-9160. [PMID: 34050801 DOI: 10.1007/s00330-021-08063-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 05/07/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The failure rate following prostate artery embolization (PAE) is around 20%, which may in part result from inadequate embolization. Prostate contrast retention (PCR) adequacy on immediate post-embolization cone-beam CT may provide better assessment of embolization completeness than arterial contrast stasis seen on fluoroscopy alone. The aim of this study was to evaluate outcomes of PAE using PCR adequacy as the procedural endpoint. METHODS A retrospective cohort study of all PAE cases using this technique at a single large volume center was conducted. Following initial embolization of the main prostatic arteries, if PCR was inadequate, additional embolization was performed. Technical success (adequate PCR) was defined as > 75% global prostate gland contrast staining. Clinical success was determined in accordance to CIRSE standards of practice. RESULTS One hundred sixty-five patients (mean age 68 ± 8.4 years) underwent PAE from June 2017 to March 2019. Technical and clinical success rates were 98.8% and 96.4% respectively. Clinical success rate was significantly higher in patients with adequate PCR. International Prostate Symptom Scores (IPSS) and Quality of Life (QoL) scores significantly improved at 1-, 3-, 6-, and 12-month follow-up when compared to baseline. Prostate volume (PV) and post-voiding residual bladder volume were significantly reduced at 3, 6, and 12 months in comparison to baseline. Mild (Clavien-Dindo grade I/II) and moderate (grade III) complication rates were 12.1% and 3.6% respectively. CONCLUSIONS By using PCR adequacy as a guide to determine the procedure endpoint for PAE, it may be possible to achieve more complete embolization and thus higher clinical success rates. KEY POINTS • By using PCR adequacy as a guide to determine the procedure endpoint for PAE, it may be possible to achieve more complete embolization and thus higher clinical success rates.
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Affiliation(s)
- Antoine Hakimé
- Department of Interventional Radiology, American Hospital of Paris, Neuilly-sur-Seine, Paris, France.
- Department of Radiology, Hôpital Sud Francilien, Corbeil-Essonnes, France.
| | - Jimmy Kyaw Tun
- Department of Interventional Radiology, The Royal London Hospital, Barts Health NHS Trust, London, E1 1BB, UK
| | - François Haab
- Department of Urology, American Hospital of Paris, Neuilly-sur-Seine, Paris, France
| | - Jean Luc Sarrazin
- Department of Interventional Radiology, American Hospital of Paris, Neuilly-sur-Seine, Paris, France
| | - Thierry De Baere
- Department of Surgical Radiology, Institut Gustave Roussy, Villejuif, France
| | - Lambros Tselikas
- Department of Surgical Radiology, Institut Gustave Roussy, Villejuif, France
| | - Viseth Kuoch
- Department of Radiology, Hôpital Sud Francilien, Corbeil-Essonnes, France
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Xiang P, Guan D, Du Z, Hao Y, Yan W, Wang Y, Liu Y, Liu D, Ping H. Efficacy and safety of prostatic artery embolization for benign prostatic hyperplasia: a systematic review and meta-analysis of randomized controlled trials. Eur Radiol 2021; 31:4929-46. [PMID: 33449181 DOI: 10.1007/s00330-020-07663-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 12/13/2020] [Accepted: 12/22/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To investigate the efficacy and safety of prostatic artery embolization (PAE) vs. transurethral resection of the prostate (TURP) in patients affected by benign prostatic hyperplasia (BPH). We also reviewed mean changes from baseline in PAE at selected follow-up points. METHODS PubMed, Web of Science, and Embase were searched up to May 1, 2020. Randomized controlled trials on PAE were collected according to specific inclusion and exclusion criteria. Meta-analyses were performed using RevMan 5.3, STATA 14, and GraphPad Prism 8. Pooled patient-reported scores and functional outcomes were calculated by using a fixed or random-effect model. RESULTS Eleven articles met our selection criteria and ten independent patient series were included in the final analysis. Pooled estimates suggested no significant difference between TURP and PAE for patient-reported outcomes including International Prostate Symptom Score (2.32 (- 0.44 to 5.09)) and quality of life (0.18 (- 0.41 to 0.77)) at 12 months. PAE was less effective regarding improvements in most functional outcomes such as maximum flow rate, prostate volume, and prostate-specific antigen. Moreover, PAE may be associated with relatively fewer complications, lower cost, and shorter hospitalization. After the PAE procedure, the overall weighted mean differences for all outcomes except sexual health scores were significantly improved from baseline during follow-up to 24 months. CONCLUSION PAE is non-inferior to TURP with regard to improving patient-reported outcomes, though most functional parameters undergo more changes after TURP than after PAE. Moreover, PAE can significantly continue to relieve symptoms for 24 months without causing serious complications. KEY POINTS • PAE is as effective as TURP in improving subjective symptom scores, with fewer complications and shorter hospitalization times. • PAE is inferior to TURP in the improvement of most functional outcomes. • Improvements due to PAE are durable during follow-up to 24 months.
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Lokeshwar SD, Valancy D, Lima TFN, Blachman-Braun R, Ramasamy R. A Systematic Review of Reported Ejaculatory Dysfunction in Clinical Trials Evaluating Minimally Invasive Treatment Modalities for BPH. Curr Urol Rep 2020; 21:54. [PMID: 33104947 DOI: 10.1007/s11934-020-01012-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2020] [Indexed: 12/30/2022]
Abstract
PURPOSE OF REVIEW To explore the sexual outcomes following the novel minimally invasive surgical procedures for benign prostatic hyperplasia- (BPH-) related lower urinary tract symptoms (LUTS), with an emphasis on ejaculatory dysfunction (EjD). RECENT FINDINGS A database search with a 10-year time restriction was carried out until February 20, 2020 using MEDLINE through the PubMed Platform evaluating minimally invasive treatment modalities for BPH and their effect on EjD. After the article selection, we retrieved data for men randomized in 19 different studies with results in 40 separate published articles investigating minimally invasive BPH surgery and reporting EjD rates. To date, water vapor thermal therapy or Rezūm, prostatic urethral lift (PUL) or UroLift®, prostate artery embolization (PAE), and Aquablation showed acceptable rates (< 2%) of retrograde ejaculation by 1 year and had very low adverse events related to the procedure. Both PUL and Rezūm demonstrated lower rates when compared with PAE and Aquablation. With comparable sexual side effect profiles postoperatively, clinicians may determine which therapeutic modality is optimal for patients based on efficacy and cost-benefit. Further randomized clinical trials are required to directly compare the effect of novel minimally invasive surgical procedures for BPH-related LUTS on ejaculation and sexual function.
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Affiliation(s)
- Soum D Lokeshwar
- Department of Urology, Yale Univeristy School of Medicine, 333 Cedar Street, New Haven, CT, 06520-8058, USA
| | - David Valancy
- Department of Urology, Miller School of Medicine, University of Miami, 1120 NW 14th Street, 15th Floor, Miami, FL, 33136, USA
| | - Thiago Fernandes Negris Lima
- Department of Urology, Miller School of Medicine, University of Miami, 1120 NW 14th Street, 15th Floor, Miami, FL, 33136, USA
| | - Ruben Blachman-Braun
- Department of Urology, Miller School of Medicine, University of Miami, 1120 NW 14th Street, 15th Floor, Miami, FL, 33136, USA
| | - Ranjith Ramasamy
- Department of Urology, Miller School of Medicine, University of Miami, 1120 NW 14th Street, 15th Floor, Miami, FL, 33136, USA.
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Pisco JM, Bilhim T, Costa NV, Torres D, Pisco J, Pinheiro LC, Oliveira AG. Randomised Clinical Trial of Prostatic Artery Embolisation Versus a Sham Procedure for Benign Prostatic Hyperplasia. Eur Urol 2020; 77:354-62. [DOI: 10.1016/j.eururo.2019.11.010] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 11/12/2019] [Indexed: 11/19/2022]
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Bilhim T. Endovascular Resection of the Prostate: How Much Is Enough for Prostate Artery Embolization? J Vasc Interv Radiol 2019; 30:225-7. [DOI: 10.1016/j.jvir.2018.10.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Accepted: 10/10/2018] [Indexed: 11/23/2022] Open
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