Prostatic arterial embolization for the treatment of lower urinary tract symptoms as a result of large benign prostatic hyperplasia: A prospective single-center investigation.

ABSTRACT

OBJECTIVE: To evaluate the effectiveness and safety of prostatic arterial embolization as a primary treatment for patients with lower urinary tract symptoms as a result of large benign prostatic hyperplasia. METHODS: A total of 64 patients with prostates >80 mL were included in the study. Prostatic arterial embolization was carried out using a combination of 50-µm and 100-µm particles. Clinical follow up was carried out using the International Prostate Symptom Score, quality of life, peak urinary flow, postvoid residual volume, International Index of Erectile Function Short Form, prostate-specific antigen, and prostatic volume at 1, 3, 6 and every 6 months thereafter. RESULTS: Prostatic arterial embolization was technically successful in 60 of 64 patients (93.8%). Follow-up data were available for 60 patients with a mean of 18 months. A clinical improvement, defined as reduction of International Prostate Symptom Score and increase of peak urinary flow, at 1 month, 3 months, 6 months, 12 months and 24 months, was achieved in 95.0%, 95.0%, 93.3%, 92.6% and 90.5%, respectively. A total of 42 patients had completed the follow up at 24 months after prostatic arterial embolization. There was an improvement in terms of mean International Prostate Symptom Score (pre-prostatic arterial embolization vs post-prostatic arterial embolization 27.0 vs 8.0; P < 0.01), mean quality of life (5.5 vs 2.0; P < 0.01), mean peak urinary flow (7.0 vs 13.0; P < 0.01), mean postvoid residual volume (130 vs 45.0; P < 0.05) and prostatic volume (121.0 vs 71.5, reduction of 40.9%; P < 0.01) were significantly different with respect to baseline. CONCLUSION: Prostatic arterial embolization seems to be a safe and effective treatment method for patients with lower urinary tract symptoms as a result of large benign prostatic hyperplasia, and it might play an important role for patients in whom medical therapy has failed, who are not candidates for surgical treatment.