Prostate artery embolization effective for benign prostatic hyperplasia
Prostate artery embolization (PAE) is safe and effective in treating patients with moderate-to-severe benign prostatic hyperplasia (BPH), a recent prospective study has shown.
“The success rate of PAE in relieving complete urinary outflow obstruction in patients with BPH was around 90 percent in our study, with no complication or sexual dysfunction after the procedure,” reported lead investigator Professor Simon Yu of the Department of Imaging and Interventional Radiology, Chinese University of Hong Kong. [Cardiovasc Intervent Radiol 2017;40:33-40]
Between June 2015 and December 2016, Yu and colleagues performed PAE in 21 patients with BPH who required a long-term bladder catheter due to complete urinary bladder outflow obstruction. The obstruction was successfully relieved in 19 patients within 2 weeks after PAE, and these patients had their catheter weaned off.
“Their median International Prostate Symptom Score improved from 21 at baseline to 6 at 1 month and 2 at 12 months after PAE, indicating that the procedure was highly effective,” reported Yu.
Likewise, the patients’ quality of life, urine peak flow rate and postvoiding residual urine volume were found to be significantly improved at 1, 3, 6 and 12 months after PAE, while their erectile function remained unchanged. These treatment outcomes were comparable to outcomes in the control group of 37 BPH patients without acute urinary retention who also underwent PAE.
About 32 percent of the patients experienced dysuria, prostate pain, urethral and/or anal pain after PAE. Fever and bleeding were reported in 3.4 percent and 27.5 percent of the patients, respectively.
“Existing treatment options for BPH include medications such as alpha adrenergic receptor antagonists and 5-alpha reductase inhibitors, and surgical treatment such as transurethral resection of prostate [TURP],” explained Yu. “However, TURP is associated with a number of complications, including retrograde ejaculation, urinary incontinence, erectile dysfunction, urethral stricture and surgical retreatment for lower urinary tract symptoms.”
PAE is a minimally invasive procedure. It involves embolization of prostatic arteries using microspheres 100–300 µm in diameter through superselective catheterization of the arteries under X-ray control. The embolization leads to ischaemic necrosis and reduction of prostate volume, thereby relieving urinary bladder outflow obstruction.
“However, PAE may also cause inadvertent embolization of the bladder, rectum or penis, leading to ischaemic necrosis of these organs. This complication may arise from intraprostate anastomoses that connect prostatic arteries to the arteries of these organs, causing shunting of embolization microspheres,” noted Yu. “Doctors performing PAE have to identify and embolize such anastomoses to protect these organs. Adequate training is therefore necessary.”
“Future research will focus on improving the safety and selection criteria of PAE. We will also compare the efficacy of PAE with medical treatment,” he added.
BPH is common among old men and the prevalence increases with age. Approximately 360,000 men in Hong Kong are estimated to have symptomatic BPH.