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CardioVascular and Interventional Radiology

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01-03-2017 | Clinical Investigation

Recurrence of Lower Urinary Tract Symptoms Following Prostate Artery Embolization for Benign Hyperplasia: Single Center Experience Comparing Two Techniques

Authors: Francisco Cesar Carnevale, Airton Mota Moreira, Sardis Honoria Harward, Shivank Bhatia, Andre Moreira de Assis, Miguel Srougi, Giovanni Guido Cerri, Alberto Azoubel Antunes

Published in: CardioVascular and Interventional Radiology | Issue 3/2017

Abstract

Purpose

To compare recurrence of lower urinary tract symptoms (LUTS) recurrence at 12 months following original prostate artery embolization (oPAE) or “proximal embolization first, then embolize distal” (PErFecTED) PAE for benign prostatic hyperplasia (BPH).

Materials and Methods

105 consecutive patients older than 45 years, with prostate size greater than 30 cm³, International Prostate Symptom Score (IPSS) ≥ 8, quality of life (QoL) index ≥ 3, and refractory status or intolerance of medical management were prospectively enrolled between June 2008 and August 2013. The study was IRB-approved, and all patients provided informed consent. Patients underwent oPAE or PErFecTED PAE and were followed for at least 12 months. Technical success was defined as bilateral embolization and clinical success (non-recurrence) was defined as removal of the Foley catheter in patients with urinary retention, IPSS < 8 and QoL index < 3 at 12 months of follow-up. Nonparametric statistics were used to compare the study groups due to the size of the study population and distributions of clinical data.

Results

97 patients had 12-month data and were categorized as oPAE without recurrence (n = 46), oPAE with recurrence (n = 13), PErFecTED without recurrence (n = 36), or PErFecTED with recurrence (n = 2). Recurrence was significantly more common in oPAE patients (χ ², p = 0.026). Unilateral embolization was significantly associated with recurrence among patients who underwent oPAE (χ ², p = 0.032).

Conclusions

Both oPAE and PErFecTED PAE are safe and effective methods for treatment of LUTS, but PErFecTED PAE is associated with a significantly lower rate of symptom recurrence.

Carnevale FC, Antunes AA, da Motta Leal Filho JM, de Oliveira Cerri LM, Marcelino ASZ, et al. Prostatic artery embolization as a primary treatment for benign prostatic hyperplasia: preliminary results in two patients. Cardiovasc Interv Radiol. 2010;. doi:10.1007/s00270-009-9727-z.

Carnevale FC, da Motta Leal Filho JM, Antunes AA, Baroni RH, Freire GC, Cerri LM, et al. Midterm follow-up after prostate embolization in two patients with benign prostatic hyperplasia. Cardiovasc Interv Radiol. 2011;. doi:10.1007/s00270-011-0136-8.

Pisco J, Pinheiro LC, Bilhim T, Duarte M, Rio Tinto H, Fernandes L, et al. Prostatic arterial embolization for benign prostatic hyperplasia: short- and intermediate-term results. Radiology. 2013;. doi:10.1148/radiol/12111601.PubMed

Gao YA, Huang Y, Zhang R, Yang YD, Zhang Q, Hou M, et al. Benign prostatic hyperplasia: prostatic arterial embolization versus transurethral resection of the prostate—a prospective, randomized, and controlled trial. Radiology. 2014;. doi:10.1148/radiol.13122803.

Kurbatov D, Russo GI, Lepetukhin A, Dubsky S, Sitkin I, Morgia G, et al. Prostatic artery embolization for prostate volume greater than 80 cm³: results from a single-center prospective study. Urology. 2014;84:400–4.CrossRefPubMed

Pisco JM, Tinto HR, Campos Pinheiro L, Bilhim T, Duarte M, Fernandes L, et al. Embolisation of prostatic arteries as treatment of moderate to severe lower urinary tract symptoms (LUTS) secondary to benign hyperplasia: results of short- and mid-term follow-up. Eur Radiol. 2013;23:2561–72.CrossRefPubMed

Grosso M, Balderi A, Arnò M, Sortino D, Antonietti A, Pedrazzini F, et al. Prostatic artery embolization in benign prostatic hyperplasia: preliminary results in 13 patients. Radiol Med. 2015;120:361–8.CrossRefPubMed

Carnevale FC, Moreira AM, Antunes AA. The “PErFecTED technique”: proximal embolization first, then embolize distal for benign prostatic hyperplasia. Cardiovasc Interv Radiol. 2014;. doi:10.1007/s00270-014-0908-z.

Amouyal G, Thiounn N, Pellerin O, Yen-Ting L, Del Giudice C, Dean C, et al. Clinical results after prostatic artery embolization using the PErFecTED technique: a single-center study. Cardiovasc Interv Radiol. 2015;. doi:10.1007/s00270-015-1267-0.

10.

Carnevale FC, Iscaife A, Yoshinaga EM, Moreira AM, Antunes AA, Srougi M. Transurethral resection of the prostate (TURP) versus original and PErFecTED prostate artery embolization (PAE) for treatment of bladder outlet obstruction due to benign prostatic hyperplasia (BPH): preliminary results of a single center, prospective, urodynamic-controlled analysis. Cardiovasc Interv Radiol. 2015;. doi:10.1007/s00270-015-1202-4.

11.

Carnevale FC, da Motta Leal Filho JM, Antunes AA, Baroni RH, Marcelino AS, Cerri LM, et al. Quality of life and clinical symptom improvement support prostatic artery embolization for patients with acute urinary retention caused by benign prostatic hyperplasia. J Vasc Interv Radiol. 2013;24:535–42.CrossRefPubMed

12.

Antunes AA, Carnevale FC, da Motta Leal Filho JM, Yoshinaga EM, Cerri LM, Baroni RH, et al. Clinical, laboratorial, and urodynamic findings of prostatic artery embolization for the treatment of urinary retention related to benign prostatic hyperplasia: a prospective single-center pilot study. Cardiovasc Interv Radiol. 2013;. doi:10.1007/s00270-013-0611-5.

13.

de Assis AM, Moreira AM, da Paula Rodrigues VC, Yoshinaga EM, Antunes AA, Harward SH, et al. Prostatic artery embolization for treatment of benign prostatic hyperplasia in patients with prostates >90 g: a prospective single-center study. J Vasc Interv Radiol. 2015;26:87–93.CrossRefPubMed

14.

Abrams P. Bladder outlet obstruction index, bladder contractility index and bladder voiding efficiency: three simple indices to define bladder voiding function. BJU Int. 1999;84:14–5.CrossRefPubMed

15.

Nitti NW. Pressure flow urodynamic studies: the gold standard for diagnosing bladder outlet obstruction. Rev Urol. 2005;7:S14–21.PubMedPubMedCentral

16.

Schäfer W, Abrams P, Liao L, et al. Good urodynamic practices: uroflowmetry, filling cystometry, and pressure-flow studies. Neurourol Urodyn. 2002;21:261–74.CrossRefPubMed

17.

Carnevale FC, Antunes AA. Prostatic artery embolization for enlarged prostates due to benign prostatic hyperplasia: how I do it. Cardiovasc Interv Radiol. 2013;. doi:10.1007/s00270-013-0680-5.

18.

National Cancer Institute. Common Terminology Criteria for Adverse Events version 4.0. NIH publication # 09-7473. Accessed on 29 May 2009.

19.

DeMeritt JS, Elmasri FF, Esposito MP, Rosenberg GS. Relief of benign prostatic hyperplasia-related bladdere outlet obstruction after transarterial polyvinyl alcohol prostate embolization. J Vasc Interv Radiol. 2000;11:767–70.CrossRefPubMed

20.

Lebdai S, Delongchamps NB, Sapoval M, Robert G, Amouyal G, Thiounn N, et al. Early results and complications of prostatic arterial embolization for benign prostatic hyperplasia. World J Urol. 2015;. doi:10.1007/s00345-015-1665-6.PubMedCentral

21.

McWilliams JP, Kuo MD, Rose SC, Bagla S, Caplin DM, Cohen EI, et al. Society of Interventional Radiology position statement: prostate artery embolization for treatment of benign disease of the prostate. J Vasc Interv Radiol. 2014;25:1349–51.CrossRefPubMed

22.

Jones P, Rai BP, Nair R, Somani BK. Current status of prostate artery embolization for lower urinary tract symptoms: review of world literature. Urology. 2015;86(4):676–81.CrossRefPubMed

23.

Li Q, Duan F, Wang MQ, Zhang GD, Yuan K. Prostatic arterial embolization with small sized particles for the treatment of lower urinary tract symptoms due to large benign prostatic hyperplasia: preliminary results. Chin Med J. 2015;128:2072–7.CrossRefPubMedPubMedCentral

24.

Bilhim T, Pisco J, Tinto HR, Fernandes L, Campos Pinheiro L, Duarte M, et al. Unilateral versus bilateral prostatic arterial embolization for lower urinary tract symptoms in patients with prostate enlargement. Cardiovasc Interv Radiol. 2013;. doi:10.1007/s00270-012-0528-4.

25.

Moreira AM, Marques CFS, Antunes AA, Nahas CS, Nahas SC, de Gregorio Ariza MA, et al. Transient ischemic rectitis as a potential complication after prostatic artery embolization: case report and review of the literature. Cardiovasc Interv Radiol. 2013;36:1690–4.CrossRef

26.

Laborda A, de Assis AM, Ioakeim I, Sánchez-Ballestín M, Carnevale FC, de Gregorio MA. Radiodermitis after prostatic artery embolization: case report and review of the literature. Cardiovasc Interv Radiol. 2015;. doi:10.1007/s00270-015-1083-6.

27.

Ahyai SA, Gilling P, Kaplan SA, Kuntz RM, Madersbacher S, Montorsi F, et al. Meta-analysis of functional outcomes and complications following transurethral procedures for lower urinary tract symptoms resulting from benign prostatic enlargement. Eur Urol. 2010;58:384–97. doi:10.1016/i.eururo.2010.06.005.CrossRefPubMed

28.

Bachmann A, Tubaro A, Barber N, d’Ancona F, Muir G, Witzsch U, et al. 180-W XPS GreenLight Laser Vaporisation versus transurethral resection of the prostate for the treatment of benign prostatic obstruction: 6-month safety and efficacy results of a multicentre randomised trial—the GOLIATH study. Eur Urol. 2014;65:931–42.CrossRefPubMed

29.

Cornu JN, Ahyai S, Bachmann A, de la Rosette J, Gilling P, Graztke C, et al. A systematic review and meta-analysis of functional outcomes and complications following transurethral procedures for lower urinary tract symptoms resulting from benign prostatic obstruction: an update. Eur Urol. 2015;67:1066–96.CrossRefPubMed

30.

Wang MQ, Wang Y, Yan JY, Yuan K, Zhang GD, Duan F, et al. Prostatic artery embolization for the treatment of symptomatic benign prostatic hyperplasia in men ≥75 years: a prospective single-center study. World J Urol. 2016;34(9):1275–83.CrossRefPubMed

Title: Recurrence of Lower Urinary Tract Symptoms Following Prostate Artery Embolization for Benign Hyperplasia: Single Center Experience Comparing Two Techniques
Authors: Francisco Cesar Carnevale
Airton Mota Moreira
Sardis Honoria Harward
Shivank Bhatia
Andre Moreira de Assis
Miguel Srougi
Giovanni Guido Cerri
Alberto Azoubel Antunes
Publication date: 01-03-2017
Publisher: Springer US
Published in: CardioVascular and Interventional Radiology / Issue 3/2017
Print ISSN: 0174-1551
Electronic ISSN: 1432-086X
DOI: https://doi.org/10.1007/s00270-017-1569-5

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Recurrence of Lower Urinary Tract Symptoms Following Prostate Artery Embolization for Benign Hyperplasia: Single Center Experience Comparing Two Techniques

Abstract

Purpose

Materials and Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose

Materials and Methods

Results

Conclusions

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