Patterns of Reperfusion and Clinical Findings in Repeat Prostate Artery Embolisation for Recurrent Lower Urinary Tract Symptoms in Patients with Benign Prostatic Hyperplasia
AbstractPurposeTo present our experience of the patterns of revascularisation of the prostate and efficacy of repeat prostate artery embolisation (rPAE) in patients with recurrence of lower urinary tract symptoms.Materials and MethodsWe retrospectively analysed 12 patients who underwent rPAE at a single centre between November 2015 and March 2020. The patients had their intraprocedural angiography and cone beam CT images as well as their pre-procedural CT retrospectively reviewed to establish the patterns of revascularisation. Clinical follow-up occurred at a minimum of 3 months.Results11/12 patients (91.6%) had significant international prostate symptom score (IPSS) reduction following rPAE with change in mean IPSS from 18.4 to 8.1 at 3 months (p
Conclusion Anatomic variations are common in internal iliac artery and prostatic artery showing racial and individual differences. Following a standard classification system to identify the origin of the PA is crucial and being aware of the most common types in your population will make PAE a faster and safer procedure. PMID: 32927930 [PubMed - as supplied by publisher]
AbstractPurposeTo assess radiation exposure in men undergoing prostate artery embolization (PAE) for the treatment for symptomatic, benign prostatic hyperplasia depending on growing experience of interventional radiologists over a 4-year period.MethodsA total of 250 consecutive patients underwent PAE at a single center. Data on radiation exposure [dose area product (DAP), effective dose (ED), entrance skin dose (ESD), and fluoroscopy time (FT)] were retrospectively evaluated. Primary outcomes of interest were patient radiation exposure in five consecutive groups of 50 patients each and Pearson correlation with the number o...
ConclusionsTortuosity of pelvic arteries was more frequent in older patients and predicted worse technical outcomes of PAE. PA origin from obturator artery was associated with lower DAP and fluoroscopy time, especially compared with PA origin from superior vesical artery. Interventionalist experience showed significant influence on technical outcome.
Objectives The aim of this study was to evaluate the feasibility of a computed tomography (CT) protocol enabling the visualization of the prostatic artery (PA) before prostatic artery embolization (PAE) in benign prostatic hyperplasia, which provides quantitative perfusion information of the prostate gland. Materials and Methods In this institutional review board–approved study, 22 consecutive patients (mean age, 67 ± 7 years) who were planned to undergo PAE underwent a dynamic CT scan of the pelvis (scan range, 22.4 cm; cycle time, 1.5 seconds; scan time, 44 seconds; 25 scan cycles; 70 kVp; 100 mAs) afte...
Obsidio Inc., a medical device company based in Columbia, South Carolina, has developed an embolic hydrogel (called a gel embolic material: GEM) designed to be delivered minimally invasively through a clinical catheter for blood vessel occlusion. App...
ConclusionsIntraprocedural cone-beam CT in combination with 3D guidance software allows for identification and catheterization of the prostatic artery in PAE. Furthermore, the results of this trial indicate that this study protocol may lead to a low overall radiation dose.
Chronic kidney disease (CKD) secondary to obstructive uropathy is a known complication of advanced benign prostatic hyperplasia (BPH) (1). Prostatic artery embolization (PAE) effectively treats lower urinary tract symptoms related to BPH and relieves urinary obstruction but requires angiography, typically with iodinated contrast material, which is relatively contraindicated in CKD. This case of obstructive uropathy was treated with PAE performed with predominantly carbon dioxide (CO2) contrast material.
A 62-year-old man with medication-refractory benign prostatic hyperplasia on Flomax had a unilateral right prostatic artery (PA) that supplied both hemispheres of the prostate gland. Before PA embolization, his International Prostate Symptom Score was 28 (extremely symptomatic) and his quality-of-life score was 6 (terrible). A left internal iliac angiogram (Fig 1) demonstrated anterior and posterior divisions without visualizing a PA, which was confirmed by DynaCT (Siemens Medical Solutions USA, Inc, Malvern, Pennsylvania) (not pictured).
CONCLUSION: PAE reduced LUTS symptoms in most patients without severe complications. The treatment did not exclude additional surgical treatment when needed. PMID: 30450921 [PubMed - as supplied by publisher]
ConclusionThis study proposes a new classification of intra-/extra-prostatic arterial distribution of the PA that could be helpful to prevent complications of PAE. Further prospective angiographic investigations are necessary to confirm its clinical value.