Outpatient BPH Procedure Works
CHICAGO—Prostatic artery embolization (PAE), a new outpatient interventional radiology treatment that blocks the blood supply to enlarged prostate glands, achieves outcomes similar to those of transurethral resection of the prostate (TURP), according to Portuguese researchers.
“This study is significant because it shows comparable clinical results to transurethral resection of the prostate or TURP without the risks of surgery, such as sexual dysfunction, urinary incontinence, blood loss and retrograde ejaculation,” said lead investigator João Martins Pisco, MD, Professor of Interventional Radiology at the Faculty of Medical Sciences, New University of Lisbon.
Dr. Pisco, who presented the study findings at the Society of Interventional Radiology 2011 Annual Scientific Meeting, said PAE should replace TURP as the new standard of care for benign prostatic hyperplasia. Although symptom improvement with PAE and TURP is comparable, certain urodynamic results, such as urinary flow rate, improve more with TURP.
The researchers evaluated the short-term and medium-term results of PAE in patients with symptomatic BPH with polyvinyl alcohol (PVA) particles 100 or 200 μm. There were 84 men in the study and all had symptomatic BPH after failure with medical therapy for six months. The mean age of the patients was 72.6 years (age range 52-85 years). Among these patients, 16 had urinary retention with a bladder catheter and four patients had TURP 14, 10, eight, and four years before.
Dr. Pisco and his colleagues evaluated prostate volume, PSA levels, peak urinary flow, and post voiding residual volume, International Prostate Symptom Score (IPSS), and International Index Erectile Function (IIEF) before PAE and again at one, three, and six months and every six months thereafter. The mean prostate volume before undergoing PAE was 84.6 cc.
All the procedures were performed under local anesthesia using a single femoral approach with a C2F5 and a micro catheter. The prostatic arteries on both sides were embolized. The investigators used nonspherical PVA particles 200 μm in the first 14 patients and 100 μm were used in subsequent patients. Follow-up was performed between 1 and 18 months (mean follow-up 9.2 months) after PAE.
PAE was technically successful in 83 of the 84 patients (98.5%). In 77 patients with clinical success, at last follow-up, all evaluated parameters showed significant clinical improvement. Six patients had “slight improvement” and one had no improvement because of incomplete embolization. Two hours after PAE, most men were passing urine less frequently. “There is no sexual dysfunction following prostatic artery embolization, and a quarter of our patients report that sexual function improved after the procedure,” Dr. Pisco told Renal & Urology News.
Dr. Pisco said better results were obtained with 100 μm PVA particles compared to the 200 μm PVA particles. Almost all procedures were performed on an outpatient basis, with patients discharged within four to eight hours after the procedure.
TURP can be performed only on prostates smaller than 60- 80 cc, but there is no size limitation with PAE, Dr. Pisco said. “The best results are obtained on patients with prostates larger than 60 cc and with very severe symptoms,” he observed.
“PAE may be the only feasible and effective treatment for benign prostate hyperplasia in those men who cannot have TURP due to the size of their prostate or because it is inadvisable for them to undergo general anesthesia.”