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Altman R, Ferreira R, Barragan C, Bhojani N, Lajkosz K, Zorn KC, Chughtai B, Annamalai G, Elterman DS. Comparing prostatic artery embolization to surgical and minimally invasive procedures for the treatment of benign prostatic hyperplasia: a systematic review and meta-analysis. BMC Urol 2024; 24:22. [PMID: 38281906 PMCID: PMC10822184 DOI: 10.1186/s12894-023-01397-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Accepted: 12/28/2023] [Indexed: 01/30/2024] Open
Abstract
BACKGROUND To summarize current evidence to report a comparative systematic review and meta-analysis of prostatic artery embolization (PAE) with transurethral resection of the prostate (TURP) and open simple prostatectomy (OSP) for the treatment of benign prostatic hyperplasia (BPH). METHODS A systematic literature search was performed to identify studies published from inception until August 2021. The search terms used were (prostate embolization OR prostatic embolization) AND (prostatic hyperplasia OR prostatic obstruction) as well as the abbreviations of PAE and BPH. Risk of bias was assessed using the Cochrane Risk of Bias tool for randomized controlled trials (RCTs) and the Risk of Bias in Non-randomized Studies-of Interventions (ROBINS-I) tool for observational studies. Random-effects meta-analysis was performed using Revman 5.4. RESULTS Seven studies were included with 810 patients: five RCTs and one observational study compared PAE with TURP, and one observational study compared PAE with OSP. The included studies had considerable risk of bias concerns. TURP and OSP were associated with more statistically significant improvements in urodynamic measures and BPH symptoms compared to PAE. However, PAE seems to significantly improve erectile dysfunction compared to OSP and improve other outcome measures compared to TURP, although not significantly. PAE appeared to reduce adverse events and report more minor complications compared with TURP and OSP, but it is unclear whether PAE is more effective in the long-term. CONCLUSION PAE is an emerging treatment option for patients with symptomatic BPH who cannot undergo surgery or have undergone failed medical therapy. Overall, PAE groups reported fewer adverse events. Future ongoing and longer-term studies are needed to provide better insight into the benefit of PAE compared to other treatment options.
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Affiliation(s)
- Rachel Altman
- Division of Urology, Department of Surgery, University Health Network, Toronto, ON, Canada
| | - Roseanne Ferreira
- Division of Urology, Department of Surgery, University Health Network, Toronto, ON, Canada
| | - Camilo Barragan
- Department of Vascular and Interventional Radiology, University Health Network, Mount Sinai Hospital, Toronto, ON, Canada
| | - Naeem Bhojani
- Department of Surgery, University of Montreal Hospital Center, Montreal, QC, Canada
| | - Katherine Lajkosz
- Department of Biostatistics, University Health Network/Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Kevin C Zorn
- Department of Surgery, University of Montreal Hospital Center, Montreal, QC, Canada
| | - Bilal Chughtai
- Department of Urology, Weill Cornell Medical College, New York, NY, USA
| | - Ganesan Annamalai
- Department of Vascular and Interventional Radiology, University Health Network, Mount Sinai Hospital, Toronto, ON, Canada
- Department of Vascular and Interventional Radiology, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Dean S Elterman
- Division of Urology, Department of Surgery, University Health Network, Toronto, ON, Canada.
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Maclean D, Vigneswaran G, Maher B, Hadi M, Harding J, Harris M, Bryant T, Hacking N, Modi S. The Effect of Protective Coil Embolization of Penile Anastomoses during Prostatic Artery Embolization on Erectile Function: A Propensity-Matched Analysis. J Vasc Interv Radiol 2023; 34:218-224.e1. [PMID: 36283591 DOI: 10.1016/j.jvir.2022.10.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 09/15/2022] [Accepted: 10/13/2022] [Indexed: 11/07/2022] Open
Abstract
PURPOSE To explore whether coil embolization of penile collateral arteries to prevent nontarget embolization during prostatic artery embolization (PAE) negatively affects erectile function. MATERIALS AND METHODS Retrospective analysis was performed on a prospectively maintained multicenter PAE database on all patients with benign prostatic hyperplasia (January 2014 to July 2016). International Index of Erectile Function (IIEF-5) scores were collected at baseline and within 12 months after the procedure. A logistic regression and nearest neighbor propensity-matched analysis (matched for age, baseline IIEF-5 scores, and use of 5α-reductase inhibitors) and paired t test were used to evaluate for differential impact on IIEF-5 scores between the group of patients who underwent (unilateral) penile collateral coil embolization and a matched control group of patients who did not. RESULTS Of a total of 216 patients, 26 underwent coil protection of an accessory pudendal vessel/penile collateral. After exclusions, 22 propensity-matched pairs were identified. The mean IIEF-5 score at baseline for the coil-embolized group was 14.8 ± 8.3 (out of a possible score of 30) and that for the matched control group was 14.0 ± 7.8. At the 12-month follow-up after the procedure, the mean follow-up IIEF-5 score was 15.5 ± 8.0 for the coil-embolized group and 14.2 ± 8.2 for the matched control group. The change in IIEF-5 scores after PAE was not significantly different between the 2 groups (0.66 ± 3.8 vs 0.20 ± 2.0; P = .64; 95% CI, -1.53 to 2.44). CONCLUSIONS When penile collateral arteries were identified, protective coil embolization of penile collateral/accessory pudendal vessels during PAE was unlikely to affect erectile function negatively.
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Affiliation(s)
- Drew Maclean
- Department of Interventional Radiology, University Hospital Southampton, Southampton, United Kingdom.
| | - Ganesh Vigneswaran
- Department of Interventional Radiology, University Hospital Southampton, Southampton, United Kingdom; Cancer Sciences, University of Southampton, Southampton General Hospital, Southampton, United Kingdom
| | - Benjamin Maher
- Department of Interventional Radiology, University Hospital Southampton, Southampton, United Kingdom
| | - Mohammed Hadi
- Department of Interventional Radiology, University Hospital Southampton, Southampton, United Kingdom
| | - James Harding
- Department of Interventional Radiology, University Hospitals Coventry and Warwickshire, Coventry, United Kingdom
| | - Mark Harris
- Department of Urology, University Hospital Southampton, Southampton, United Kingdom
| | - Timothy Bryant
- Department of Interventional Radiology, University Hospital Southampton, Southampton, United Kingdom
| | - Nigel Hacking
- Department of Interventional Radiology, University Hospital Southampton, Southampton, United Kingdom
| | - Sachin Modi
- Department of Interventional Radiology, University Hospital Southampton, Southampton, United Kingdom
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Mahmoudi M, Jennings C, Pereira K, Hall AF, Arzani A. Guiding the prostatic artery embolization procedure with computational uid dynamics. J Biomech Eng 2022; 144:1140781. [DOI: 10.1115/1.4054515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Indexed: 11/08/2022]
Abstract
Abstract
Benign prostatic hyperplasia (BPH) is a common disease associated with lower urinary tract symptoms and the most frequent benign tumor in men. To reduce BPH therapy complications, prostatic artery embolization (PAE) was developed to replace the surgical options. PAE is a minimally invasive technique in which emboli are injected into the prostate arteries (PA), obstructing the blood flow in the hypervascular nodules. In this work, a personalized PAE treatment strategy was proposed using patient-specific computational fluid dynamics (CFD). First, the hemodynamics environment in the iliac arterial tree considering a large network of bifurcations was studied. The results showed complex blood flow patterns in the iliac arterial network. Subsequently, the transport of embolic particulates during PAE for the standard horizontal and a hypothetical vertical patient positioning was simulated using Lagrangian particle tracking. Emboli with different sizes were released at various locations across the iliac arterial tree. The emboli entering the PA were mapped back to their initial location to create emboli release maps (ERMs). The obtained ERMs during the standard patient positioning for smaller emboli at certain release locations showed distinct regions in which if the emboli were released within these regions, all of them would reach the PA without non-target embolization. During the hypothetical vertical patient positioning, the larger emboli formed a larger coherent region in the ERMs. Our patient-specific model can be used to find the best spatial location for emboli injection and perform the embolization procedure with minimal off-target delivery.
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Affiliation(s)
- Mostafa Mahmoudi
- Department of Mechanical Engineering, Northern Arizona University, Flagstaff, AZ, United States
| | - Chadrick Jennings
- Department of Mechanical Engineering, Northern Arizona University, Flagstaff, AZ, United States
| | - Keith Pereira
- Department of Radiology, Saint Louis University, St Louis, MO, United States
| | - Andrew F. Hall
- Department of Biomedical Engineering, Saint Louis University, St Louis, MO, United States
| | - Amirhossein Arzani
- Department of Mechanical Engineering, Northern Arizona University, Flagstaff, AZ, United States
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Diamond J, Conway AM, Carroccio A, Rosen RJ. Endovascular Interventions for the Pelvis. Interv Cardiol 2022. [DOI: 10.1002/9781119697367.ch80] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Culp WTN, Johnson EG, Giuffrida MA, Palm CA, Skorupski KA, Burton JH, Rebhun RB, Willcox JL, Kent MS, Rodriguez CO, Glaiberman CB. Procedural description and prospective evaluation of short-term outcome for the use of prostatic artery embolization in dogs with carcinoma of the prostate. J Am Vet Med Assoc 2021; 259:1154-1162. [PMID: 34727073 DOI: 10.2460/javma.20.06.0324] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To describe the procedure of prostatic artery embolization (PAE) in dogs with prostatic carcinoma and to evaluate the short-term outcome for treated dogs. ANIMALS 20 client-owned dogs with prostatic carcinomas between May 2014 and July 2017. PROCEDURES In this prospective cohort study, dogs with carcinoma of the prostate underwent PAE with fluoroscopic guidance. Before and after PAE, dogs underwent CT and ultrasonographic examinations of the prostate, and each owner completed a questionnaire about the dog's clinical signs. Results for before versus after PAE were compared. RESULTS Prostatic artery embolization was successfully performed in all 20 dogs. Tenesmus, stranguria, and lethargy were significantly less common 30 days after PAE (n = 2, 1, and 0 dogs, respectively), compared with before PAE (9, 10, and 6 dogs, respectively). Median prostatic volume was significantly less 30 days after PAE (14.8 cm3; range, 0.4 to 48.1 cm3; interquartile [25th to 75th percentile] range, 6.7 to 19.5 cm3), compared with before PAE (21.7 cm3; range, 2.9 to 77.7 cm3; interquartile range, 11.0 to 35.1 cm3). All dogs had a reduction in prostatic volume after PAE, with a median prostatic volume loss of 39.4% (95% CI, 20.3% to 59.3%). CONCLUSIONS AND CLINICAL RELEVANCE Prostatic artery embolization was associated with decreased prostate volume and improved clinical signs in this cohort. The short-term response to PAE appears promising, and evaluation of the long-term impact on survival time is needed.
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Patel N, Yung N, Vigneswaran G, de Preux L, Maclean D, Harris M, Somani B, Bryant T, Hacking N, Modi S. 1-year cost-utility analysis of prostate artery embolization (PAE) versus transurethral resection of the prostate (TURP) in benign prostatic hyperplasia (BPH). BMJ SURGERY, INTERVENTIONS, & HEALTH TECHNOLOGIES 2021; 3:e000071. [PMID: 35047801 PMCID: PMC8749306 DOI: 10.1136/bmjsit-2020-000071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Accepted: 10/01/2021] [Indexed: 11/21/2022] Open
Abstract
Objective To determine whether prostate artery embolization (PAE) is a cost-effective alternative to transurethral resection of the prostate (TURP) in the management of benign prostate hyperplasia (BPH) after 1-year follow-up. Design, setting and main outcome measures A retrospective cost-utility analysis over a 12-month time period was conducted to compare the two interventions from a National Health Service perspective. Effectiveness was measured as quality-adjusted life years (QALYs) derived from data collected during the observational UK Register of Prostate Embolisation (UK-ROPE) Study. Costs for both PAE and TURP were derived from University Hospital Southampton, a tertiary referral centre for BPH and the largest contributor to the UK-ROPE. An incremental cost-effectiveness ratio (ICER) was derived from cost and QALY values associated with both interventions to assess the cost-effectiveness of PAE versus TURP. Further sensitivity analyses involved a decision tree model to account for the impact of patient-reported complications on the cost-effectiveness of the interventions. Results The mean patient age for TURP (n=31) and PAE (n=133) was 69 and 65.6 years, respectively. In comparison to TURP, PAE was cheaper due to shorter patient stays and the lack of necessity for an operating theatre. Analysis revealed an ICER of £64 798.10 saved per QALY lost when comparing PAE to TURP after 1-year follow-up. Conclusion Our findings suggest that PAE is initially a cost-effective alternative to TURP for the management of BPH after 1-year follow-up. Due to a higher reintervention rate in the PAE group, this benefit may be lost in subsequent years. Trial registration number NCT02434575.
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Affiliation(s)
- Nikisha Patel
- Faculty of Medicine, Imperial College London, London, UK
| | - Nathan Yung
- Faculty of Medicine, Imperial College London, London, UK
| | - Ganesh Vigneswaran
- Interventional Radiology, University Hospital Southampton NHS Foundation Trust, Southampton, Hampshire, UK
| | - Laure de Preux
- Centre for Health Economics and Policy Innovation, Imperial College Business School, London, UK
| | - Drew Maclean
- Interventional Radiology, University Hospital Southampton NHS Foundation Trust, Southampton, Hampshire, UK
| | - Mark Harris
- Urology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Bhaskar Somani
- Urology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Timothy Bryant
- Interventional Radiology, University Hospital Southampton NHS Foundation Trust, Southampton, Hampshire, UK
| | - Nigel Hacking
- Interventional Radiology, University Hospital Southampton NHS Foundation Trust, Southampton, Hampshire, UK
| | - Sachin Modi
- Interventional Radiology, University Hospital Southampton NHS Foundation Trust, Southampton, Hampshire, UK
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Carnevale FC, McClure T, Cadour F, Vidal V, de Assis AM, Moreira AM, Rocha ADD, Rebet A, Nutting C. Advanced image guidance for prostatic artery embolization - a multicenter technical note. CVIR Endovasc 2021; 4:63. [PMID: 34374875 PMCID: PMC8355292 DOI: 10.1186/s42155-021-00249-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 07/26/2021] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Prostatic artery embolization (PAE) is associated with patients' quality of life improvements and limited side effects compared to surgery. However, this procedure remains technically challenging due to complex vasculature, anatomical variations and small arteries, inducing long procedure times and high radiation exposure levels both to patients and medical staff. Moreover, the risk of non-target embolization can lead to relevant complications. In this context, advanced imaging can constitute a solid ally to address these challenges and deliver good clinical outcomes at acceptable radiation levels. MAIN TEXT This technical note aims to share the consolidated experience of four institutions detailing their optimized workflow using advanced image guidance, discussing variants, and sharing their best practices to reach a consensus standardized imaging workflow for PAE procedure, as well as pre and post-operative imaging. CONCLUSIONS This technical note puts forth a consensus optimized imaging workflow and best practices, with the hope of helping drive adoption of the procedure, deliver good clinical outcomes, and minimize radiation dose levels and contrast media injections while making PAE procedures shorter and safer.
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Affiliation(s)
- Francisco Cesar Carnevale
- Department of Radiology, University of Sao Paulo Medical School, Av. Dr. Enéas Carvalho de Aguiar, 255, São Paulo, SP, 05403-000, Brazil.
| | | | | | | | - André Moreira de Assis
- Department of Radiology, University of Sao Paulo Medical School, Av. Dr. Enéas Carvalho de Aguiar, 255, São Paulo, SP, 05403-000, Brazil
| | - Airton Mota Moreira
- Department of Radiology, University of Sao Paulo Medical School, Av. Dr. Enéas Carvalho de Aguiar, 255, São Paulo, SP, 05403-000, Brazil
| | - Arthur Diego Dias Rocha
- Department of Radiology, University of Sao Paulo Medical School, Av. Dr. Enéas Carvalho de Aguiar, 255, São Paulo, SP, 05403-000, Brazil
| | | | - Charles Nutting
- Endovascular Consultants of Colorado Lone Tree, Lone Tree, Colorado, USA
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Pascoe J, Fontaine C, Hashim H. Modern advancements in minimally invasive surgical treatments for benign prostatic obstruction. Ther Adv Urol 2021; 13:17562872211030832. [PMID: 34349840 PMCID: PMC8287272 DOI: 10.1177/17562872211030832] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Accepted: 06/03/2021] [Indexed: 11/16/2022] Open
Abstract
A wide variety of minimally invasive surgical techniques are now being offered for treating voiding lower urinary tract symptoms (LUTS) secondary to benign prostatic obstruction (BPO). These options offer an alternative to both medical therapy and traditional surgical options. Minimally invasive surgical treatments in LUTS/BPO boast both day case and local anaesthetic options, with a potentially reduced side effect profile compared to traditional surgical interventions matching the needs for a range of patients. We provide a narrative review of minimally invasive surgical treatments available for BPO in terms of the technology, efficacy, safety, institutional recommendations, cost and potential future developments.
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Affiliation(s)
- John Pascoe
- Specialist Registrar in Urology, University Hospitals Plymouth, Derriford Rd, Devon PL6 8DH, UK
| | - Christina Fontaine
- Specialist Registrar in Urology, University Hospitals Plymouth, Devon, UK
| | - Hashim Hashim
- Consultant Urological Surgeon and Honorary Professor in Urology, Bristol Urological Institute, Southmead Hospital, Bristol, Somerset, UK
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Prostatic artery embolization using three-dimensional cone-beam computed tomography. Diagn Interv Imaging 2020; 101:721-725. [DOI: 10.1016/j.diii.2020.05.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 05/02/2020] [Accepted: 05/04/2020] [Indexed: 12/26/2022]
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10
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Taktak S, Jones P, Haq A, Rai BP, Somani BK. Aquablation: a novel and minimally invasive surgery for benign prostate enlargement. Ther Adv Urol 2018; 10:183-188. [PMID: 29899759 DOI: 10.1177/1756287218760518] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Accepted: 01/29/2018] [Indexed: 11/17/2022] Open
Abstract
Aquablation is a minimally invasive surgical technology for benign prostate enlargement, which uses high-pressure saline to remove parenchymal tissue through a heat-free mechanism of hydrodissection. Early results show this to be a promising surgical strategy with a strong morbidity profile and reduced resection time. This review serves to provide an overview of the technique and evaluate its safety and efficacy.
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Affiliation(s)
| | - Patrick Jones
- University Hospital Southampton NHS Foundation Trust, Tremona Rd, Southampton, SO16 6YD, UK
| | - Ahsanul Haq
- Royal Preston Hospital, Preston, Lancashire, UK
| | | | - Bhaskar K Somani
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
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