Keywords:
Obstruction / Occlusion, Embolism / Thrombosis, Embolisation, CT-Angiography, Cone beam CT, Catheter arteriography, Pelvis, Interventional vascular, Genital / Reproductive system male
Authors:
J. Vega, J. Cobos, M. Morales Garcia, J. M. Vicente Martín, E. Meilán Hernández, J. Angulo Cuesta; Getafe/ES
DOI:
10.1594/ecr2018/C-3149
Aims and objectives
Lower urinary tract symptoms (LUTS) are one of the most common complaints in elderly men,
and are usually caused by the ongoing growth of prostate tissue with advancing age that leads to compression of the prostatic urethra.
The bladder outlet obstruction secondary to benign prostate hyperplasia (BPH) can impede normal activities and even result in complications such as infections or acute urinary retention.
Management of mild symptoms might benefit from medical therapies such us α-adrenergic blockers or 5-α-reductase,
but many patients experience worsening symptoms despite medical treatment.
Prostate surgery is indicated in patients with medical refractory LUTS.
Transutethral resection of the prostate (TURPS) is considered the gold standard for moderate prostate enlargement while open prostatectomy is the first-line surgical option for men with very large prostates (>80ml).
Both medical and surgical therapies have shown significant morbidity rates,
especially in the elderly patients.
Less invasive alternative options have been developed attempting to offer the same effect as former therapies but without the surgical risk.
Prostatic artery embolization (PAE) for BPH has been proposed as an effective and safe procedure in alleviating LUTS.
PAE is a minimally invasive procedure that improves LUTS and reduces complication rates in BPH mainly by shrinking the prostate volume.
Its beneficial effect was firstly proposed by DeMerrit in 2000 after seeing that LUTS markedly improved in a man with hematuria treated with transcatheter embolization.
Ten years later,
after some studies on animal models by several groups,
Carnevale was the first one to report the successful use of PAE in two patients with BHP.
For the last seven years,
hundreds of cases have been reported,
and two randomized clinical trials have compared the efficacy and safety of PAE to that of TURPS.
Based on all this data PAE is a viable alternative to surgery in patients who are poor surgical candidates,
or in those with enlarged prostates concerned with the complications of the surgical procedures.
The purpose of our study was to evaluate safety and procedural and clinical results of PAE,
in a cohort of 16 consecutive patients with refractory LUTS secondary to BPH,
with high surgical risk.