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DOI: 10.1055/s-0042-1748758
Prostate Artery Embolization in Patients above Eighty Years Old: Clinical Efficacy and Safety
Funding The researcher's (Hossam Saro) clinical and research time at Guy's and St Thomas' Hospitals was funded by the Mission's Office, Ministry of Higher Education, Egypt.
Abstract
Objectives Prostate artery embolization (PAE) has been established as an effective treatment option for benign prostate hyperplasia or hematuria of prostatic origin. We aim to confirm the effectiveness and safety of PAE in elderly patients aged ≥ 80 years old.
Materials and Methods Between January 2014 and August 2020, PAE was attempted on 54 elderly patients with lower urinary tract symptoms (LUTS) or prostatic hematuria who were unfit for surgical treatment or opted for PAE. Outcome parameters (International Prostate Symptom Score [IPSS], quality of life [QoL] score, International Index of Erectile Function score (IIEF), maximal urinary flow rate, postvoid residual, and prostate volume) were collected and analyzed at baseline, 6 months, 1, 2, and 3 years.
Results The mean patient age was 85.29 years (range: 80–98). Technical success was achieved in 50 patients (92.6%). Mean IPSS improved from 18 at baseline to 7.7, 8.5, 8.6, and 9.1 at 6 months, 1, 2, and 3 years. Mean QoL improved from 4.9 at baseline to 2.8, 1.7, and 1.5 at 6 months, 1, and 2 years. Mean prostate volume reduced from a baseline of 152.7 to 123.5 mL within 6 months and 120.5 mL after 7 months of PAE. Urinary catheter removal was successful in 13 out of 19 patients with urinary retention. PAE succeeded in stopping bleeding in 16 out of 17 patients with prostate-induced hematuria.
Conclusion PAE is a feasible low-risk treatment for LUTS with or without urinary retention or prostatic hematuria in elderly patients.
Keywords
benign prostate hyperplasia - urinary retention - prostate-induced hematuria - prostate artery embolization - lower urinary tract symptomsEthical Consideration
The study was conducted following the approval of the research ethics board at Guy's and St Thomas' Hospitals, London, United Kingdom.
Informed consent was obtained from all participants in the study, and all procedures were approved by the research ethics board.
Publikationsverlauf
Artikel online veröffentlicht:
14. Juni 2022
© 2022. The Pan Arab Interventional Radiology Society. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)
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References
- 1 Sabharwal T, Popert R. Prostate artery embolization. BJU Int 2018; 122 (02) 167-168
- 2 Reich O, Gratzke C, Bachmann A. et al; Urology Section of the Bavarian Working Group for Quality Assurance. Morbidity, mortality and early outcome of transurethral resection of the prostate: a prospective multicenter evaluation of 10,654 patients. J Urol 2008; 180 (01) 246-249
- 3 Ahyai SA, Gilling P, Kaplan SA. 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 (03) 384-397
- 4 Ray AF, Powell J, Speakman MJ. et al. Efficacy and safety of prostate artery embolization for benign prostatic hyperplasia: an observational study and propensity-matched comparison with transurethral resection of the prostate (the UK-ROPE study). BJU Int 2018; 122 (02) 270-282
- 5 Challacombe B, Sabharwal T. Prostate artery embolisation for benign prostatic hyperplasia. BMJ 2018; 361: k2537
- 6 Bischoff W, Goerttler U. [Successful intra-arterial embolization of bleeding carcinoma of the prostate (author's transl)]. Urologe A 1977; 16 (02) 99-102
- 7 Mitchell ME, Waltman AC, Athanasoulis CA, Kerr Jr WS, Dretler SP. Control of massive prostatic bleeding with angiographic techniques. J Urol 1976; 115 (06) 692-695
- 8 Nadalini VF, Positano N, Bruttini GP, Medica M, Fasce L. [Therapeutic occlusion of the hypogastric arteries with isobutyl-2-cyanoacrylate in vesical and prostatic cancer (author's transl)]. Radiol Med (Torino) 1981; 67 (1-2): 61-66
- 9 DeMeritt JS, Elmasri FF, Esposito MP, Rosenberg GS. Relief of benign prostatic hyperplasia-related bladder outlet obstruction after transarterial polyvinyl alcohol prostate embolization. J Vasc Interv Radiol 2000; 11 (06) 767-770
- 10 Carnevale FC, Moreira AM, de Assis AM. et al. Prostatic artery embolization for the treatment of lower urinary tract symptoms due to benign prostatic hyperplasia: 10 years' experience. Radiology 2020; 296 (02) 444-451
- 11 Kuang M, Vu A, Athreya S. A systematic review of prostatic artery embolization in the treatment of symptomatic benign prostatic hyperplasia. Cardiovasc Intervent Radiol 2017; 40 (05) 655-663
- 12 Hacking N, Vigneswaran G, Maclean D. et al. Technical and imaging outcomes from the UK Registry of Prostate Artery Embolization (UK-ROPE) study: focusing on predictors of clinical success. Cardiovasc Intervent Radiol 2019; 42 (05) 666-676
- 13 Carnevale FC, Antunes AA, da Motta Leal Filho JM. et al. Prostatic artery embolization as a primary treatment for benign prostatic hyperplasia: preliminary results in two patients. Cardiovasc Intervent Radiol 2010; 33 (02) 355-361
- 14 Pisco JM, Bilhim T, Pinheiro LC. et al. Medium- and long-term outcome of prostate artery embolization for patients with benign prostatic hyperplasia: results in 630 patients. J Vasc Interv Radiol 2016; 27 (08) 1115-1122
- 15 Carnevale FC, Soares GR, de Assis AM, Moreira AM, Harward SH, Cerri GG. Anatomical variants in prostate artery embolization: a pictorial essay. Cardiovasc Intervent Radiol 2017; 40 (09) 1321-1337
- 16 Enderlein GF, Lehmann T, von Rundstedt FC. et al. Prostatic artery embolization-anatomic predictors of technical outcomes. J Vasc Interv Radiol 2020; 31 (03) 378-387
- 17 Maclean D, Maher B, Harris M. et al. Planning prostate artery embolisation: is it essential to perform a pre-procedural CTA?. Cardiovasc Intervent Radiol 2018; 41 (04) 628-632
- 18 Monreal R, Robles C, Sánchez-Casado M. et al. Embolisation of prostate arteries in benign prostatic hyperplasia in non-surgical patients. Radiologia (Engl Ed) 2020; 62 (03) 205-212
- 19 Amouyal G, Thiounn N, Pellerin O. et al. Clinical results after prostatic artery embolization using the PErFecTED technique: a single-center study. Cardiovasc Intervent Radiol 2016; 39 (03) 367-375
- 20 Andrade G, Khoury HJ, Garzón WJ. et al. Radiation exposure of patients and interventional radiologists during prostatic artery embolization: a prospective single-operator study. J Vasc Interv Radiol 2017; 28 (04) 517-521
- 21 Bagla S, Martin CP, van Breda A. et al. Early results from a United States trial of prostatic artery embolization in the treatment of benign prostatic hyperplasia. J Vasc Interv Radiol 2014; 25 (01) 47-52
- 22 Bilhim T, Pisco J, Pereira JA. et al. Predictors of clinical outcome after prostate artery embolization with spherical and nonspherical polyvinyl alcohol particles in patients with benign prostatic hyperplasia. Radiology 2016; 281 (01) 289-300
- 23 Gao YA, Huang Y, Zhang R. et al. Benign prostatic hyperplasia: prostatic arterial embolization versus transurethral resection of the prostate–a prospective, randomized, and controlled clinical trial. Radiology 2014; 270 (03) 920-928
- 24 Kearns DJ, Boardman P, Tapping CR. Patterns of reperfusion and clinical findings in repeat prostate artery embolisation for recurrent lower urinary tract symptoms in patients with benign prostatic hyperplasia. Cardiovasc Intervent Radiol 2021; 44 (01) 95-101
- 25 Braithwaite S, Boardman P, Tapping C, Macdonald A. Early total recanalization of the prostate artery and reperfusion of the prostate following particle embolization for benign prostatic hyperplasia. J Vasc Interv Radiol 2021; 32 (07) 1096-1098
- 26 Galla N, Maron SZ, Voutsinas N. et al. Adjunctive coil embolization of the prostatic arteries after particle embolization for prostatic artery embolization. Cardiovasc Intervent Radiol 2021; 44 (12) 1994-1998
- 27 Ciro CA, Ottenbacher KJ, Graham JE, Fisher S, Berges I, Ostir GV. Patterns and correlates of depression in hospitalized older adults. Arch Gerontol Geriatr 2012; 54 (01) 202-205
- 28 Pisco JM, Rio Tinto H, Campos Pinheiro L. et al. Embolisation of prostatic arteries as treatment of moderate to severe lower urinary symptoms (LUTS) secondary to benign hyperplasia: results of short- and mid-term follow-up. Eur Radiol 2013; 23 (09) 2561-2572
- 29 Malling B, Røder MA, Brasso K, Forman J, Taudorf M, Lönn L. Prostate artery embolisation for benign prostatic hyperplasia: a systematic review and meta-analysis. Eur Radiol 2019; 29 (01) 287-298
- 30 Kanthabalan A, Dawson C. Guideline for stopping anticoagulants prior to urological procedures. J Clin Urol 2017; 11 (04) 271-279