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. 2022 Dec 7;5(1):62.
doi: 10.1186/s42155-022-00337-8.

Prostatic artery embolization using reflux-control microcatheter: prospective experience addressing feasibility

André Moreira de Assis  1 , Willian Yoshinori Kawakami  2 , Airton Mota Moreira  2 , Francisco Cesar Carnevale  2
Affiliations

Prostatic artery embolization using reflux-control microcatheter: prospective experience addressing feasibility

André Moreira de Assis et al. CVIR Endovasc. .

Abstract

Purpose: To evaluate the efficacy and safety of Prostatic Artery Embolization (PAE) using a reflux control microcatheter.

Materials and methods: This is a prospective, single-center investigation that included 10 patients undergoing PAE for treatment of lower urinary tract symptoms (LUTS) attributed to benign prostate hyperplasia (BPH). Baseline, 3-month, and 12-month efficacy endpoints were obtained for all patients and included prostate-specific antigen (PSA), uroflowmetry, pelvic magnetic resonance imaging (MRI), and clinical assessment using the International Prostate Symptom Score (IPSS) questionnaire and the IPSS-Quality of life (QoL) item. Complications were assessed using the Cirse classification system.

Results: Ten patients entered statistical analysis and presented with significant LUTS improvement 12 months after PAE, as follows: mean IPSS reduction of 86.6% (2.8 vs. 20.7, - 17.9, P < 0.001), mean QoL reduction of 79.4% (1.1 vs. 5.4, - 4.3, P < 0.001), mean prostatic volume reduction of 38.4% (69.3 cm3 vs. 112.5 cm3, - 43.2 cm3, P < 0.001), mean peak urinary flow (Qmax) increase of 199.4% (19.9 mL/s vs. 6.6 mL/s, + 13.3 mL/s, P = 0.006) and mean PSA reduction of 50.1% (3.0 ng/mL vs. 6.1 ng/mL, - 3.0 ng/mL, P < 0.001). One patient (10%) needed transurethral resection of the prostate (TURP) after PAE due to a ball-valve effect. One microcatheter (10%) needed to be replaced during PAE due to occlusion. Non-target embolization was not observed in the cohort.

Conclusion: This initial experience suggests that PAE using a reflux control microcatheter is effective and safe for the treatment of LUTS attributed to BPH.

Keywords: Benign prostatic hyperplasia; Lower urinary tract symptoms; Non-target embolization; Prostate artery embolization.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
A Pre PAE T2-weighted MRI in sagittal view showing a very enlarged prostate, with a large medium lobe (grade III IPP = 26 mm). B After embolization, marked hypointense signal and volumetric reduction of the medium lobe was observed (arrows). (*) Foley balloon. A cystoscopy confirmed the presence of a necrotic medium lobe leading to ball-valve effect
Fig. 2
Fig. 2
A Selective right prostatic artery DSA in oblique view showing the normal posterolateral (PL) and anteromedial (AM) prostatic branches. Cranially, a large branch to the bladder was also observed (arrow). B Intraprocedural Cone Beam CT in coronal view confirming the findings seen in DSA. C DSA while microspheres were injected demonstrating reflux to the bladder branch (arrow). D Final DSA after embolization showing devascularization of the prostatic branches and preservation of the bladder arterial branch
See this image and copyright information in PMC

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