Clinical evaluation of embolization of the superior vesical prostatic artery for treatment of benign prostatic hyperplasia: a single-center retrospective study

Abstract

Introduction: Non-surgical minimally invasive treatments are greatly needed for patients with symptomatic benign prostatic hyperplasia (BPH), for whom medical treatment has failed and surgery is contraindicated. This study retrospectively evaluated the efficacy and safety of super-selective prostatic artery embolization (PAE) for BPH, relative to transurethral resection of the prostate (TURP).

Aim: To clinically evaluate the efficacy and safety of super-selective PAE for BPH, relative to TURP.

Material and methods: From February 2012 to March 2015, patients with BPH underwent selective PAE (n = 17) or TURP (control group; n = 40). Prostate volume, maximum urinary flow rate (Qmax), International Prostate Symptoms Score (IPSS), and quality of life (QoL) score were evaluated at baseline and postoperative 3, 6, and 12 months. Complications were also recorded.

Results: All the procedures were technically successfully. At postoperative 1 year, patients given PAE had significantly greater prostate volume (64.6 ±10.2 ml), IPSS (23.9 ±4.9), and QoL (4.1 ±0.7) compared with the control patients (42.0 ±7.5 ml, 13.1 ±3.5, and 2.1 ±0.7, respectively). The Qmax of the PAE group (9.5 ±3.7 ml/s) was significantly lower than that of the control (21.8 ±4.2 ml/s). The changes in parameters of the TURP patients relative to the preoperative baseline were significantly greater than those of the PAE group. No severe complications occurred.

Conclusions: Prostatic artery embolization was demonstrated as safe and effective and may be considered an alternative treatment for BPH patients, especially for those who are not candidates for or refuse surgery.

Keywords: benign prostatic hyperplasia; lower urinary tract symptoms; super-selective prostatic artery embolization; transurethral resection of the prostate.

Photo 1

Right pelvic angiography of a 72-year-old male patient suffering from LUTS secondary to BPH. A – The right prostate artery (down arrow) and internal pudendal artery (up arrow) before PAE. B – After PAE, the right prostate artery and internal pudendal artery are not seen

Figure 1

Comparisons of the functional parameters between PAE and TURP groups from baseline over time, including prostate volume (A), Qmax (B), IPSS (C), and QoL (D)