Prostatic arterial embolization versus holmium laser enucleation of the prostate: 1-year outcomes.

PURPOSE: Holmium Laser Enucleation of the Prostate (HoLEP) and Prostatic Artery Embolization (PAE) are novel techniques for the treatment of benign prostatic hyperplasia lower urinary tract symptoms (BPH-LUTS). The objective of this study was to describe and compare the functional results and complications of these two techniques at one year follow-up. MATERIALS AND METHODS: We performed a retrospective, monocentric study of all patients consecutively treated in our center with HoLEP or PAE for symptomatic or complicated BPH between January 2016 and December 2019. Data regarding patient and perioperative characteristics, follow-up biological results, functional questionnaires and uroflowmetry were collected from medical records. RESULTS: A total of 490 and 57 patients were treated with HoLEP and PAE, respectively. The demographic and clinical characteristics of the two groups were similar. The operative time was significantly higher for PAE (p < 0.001) and hospitalization time longer after HoLEP (p = 0.0006). The urinary catheterization time was longer after PAE (p < 0.001). The prostatic volume treated was higher with HoLEP than with PAE (56% versus 26%, p < 0.001). The mean difference in IPSS from baseline to 12 months was significantly higher after HoLEP than after PAE: - 17.58 versus - 8 (p < 0.001). The mean difference in QoL-IPSS from baseline to 12 months was significantly higher after HoLEP: - 4.09 versus - 2.27 (p < 0.001). The rate of postoperative adverse events in the first three months was similar between the two groups:35% after HoLEP and 33% after PAE (p = 0.88). CONCLUSIONS: HoLEP and PAE both significantly improved BPH-LUTS, with HoLEP having an advantage over PAE.

Prostatic Artery Origin Variability: Five Steps to Improve Identification during Percutaneous Embolization.

Background and Objectives: The purpose of the current paper is to present our study on the variability in the prostatic artery origin, discuss the less frequent origins, and present the challenges of the prostatic artery embolization (PAE) procedure, thus aiding young interventional radiologists. Materials and Methods: We studied the origins of the prostatic artery on digital subtraction angiography (DSA) examinations from PAE procedures on 35 male pelvises (70 hemi-pelvises). Results: Our study has demonstrated that the most frequent origin of the prostatic artery (PA) is the internal pudendal artery (IPA), 37.1%, followed by the anterior gluteal trunk, 27.1%, and the superior vesical artery (SVA), 21.4%. Less frequent origins are the obturator artery (OBT), 11.4%, and the inferior gluteal artery (IGA), 2.8%. Conclusions: Compared to other studies, we notice some differences in the statistical results, but the most frequent origins remain the same. What is more important for young interventional radiologists is to be aware of all the possible origins of the PA in order to be able to offer a proper treatment to their patients. The important aspect that will ensure the success of the procedure without post-procedural complications is represented by the successful embolization of the targeted prostatic parenchyma.

Minimally invasive treatments for benign prostatic hyperplasia: a Cochrane network meta-analysis.

OBJECTIVE: To assess the comparative effectiveness and ranking of minimally invasive treatments (MITs) for lower urinary tract symptoms (LUTS) in men with benign prostatic hyperplasia (BPH). MATERIALS AND METHODS: We searched multiple databases up to 24 February 2021. We included randomized controlled trials assessing the following treatments: convective radiofrequency water vapour thermal therapy (WVTT; or Rezum); prostatic arterial embolization (PAE); prostatic urethral lift (PUL; or Urolift); temporary implantable nitinol device (TIND); and transurethral microwave thermotherapy (TUMT) compared to transurethral resection of the prostate (TURP) or sham surgery. We performed a frequentist network meta-analysis. RESULTS: We included 27 trials involving 3017 men. The overall certainty of the evidence of most outcomes according to GRADE was low to very low. Compared to TURP, we found that PUL and PAE may result in little to no difference in urological symptoms, while WVTT, TUMT and TIND may result in worse urological symptoms. MITs may result in little to no difference in quality of life, compared to TURP. MITs may result in a large reduction in major adverse events compared to TURP. We were uncertain about the effects of PAE and PUL on retreatment compared to TURP, however, TUMT may result in higher retreatment rates. We were very uncertain of the effects of MITs on erectile function and ejaculatory function. Among MITs, PUL and PAE had the highest likelihood of being the most efficacious for urinary symptoms and quality of life, TUMT for major adverse events, WVTT and TIND for erectile function and PUL for ejaculatory function. Excluding WVTT and TIND, for which there were only studies with short-term (3-month) follow-up, PUL had the highest likelihood of being the most efficacious for retreatment. CONCLUSIONS: Minimally invasive treatments may result in similar or worse effects concerning urinary symptoms and quality of life compared to TURP at short-term follow-up.

An updated meta-analysis of prostatic arterial embolization versus transurethral resection of the prostate in the treatment of benign prostatic hyperplasia.

OBJECTIVE: To investigate whether prostatic arterial embolization (PAE) could be recommended as a routine therapy for benign prostatic hyperplasia (BPH), we conducted an updated meta-analysis to assess the efficacy and safety of PAE compared with transurethral resection of the prostate (TURP). METHODS: Systematic literature retrieval by searching data from Web of science, Pubmed, Embase, Cochrane Library, ClinicalTrial.gov, CNKI, Wanfang and VIP databases was carried out to identify all related trials from the inception dates to June 2019. We also conducted subgroup analyses depending on the kind of study design, kind of PAE and kind of TURP. RESULTS: Nine studies comparing PAE with TURP involving a total of 860 BPH patients were selected. Postoperative reduced IPSS score (MD 2.50; 95% CI 0.78-4.21; P = 0.004), postoperative reduced QOL score (MD 0.40; 95% CI 0.09-0.71; P = 0.01), postoperative reduced PV (MD 8.59; 95% CI 4.74-12.44; P < 0.00001) and postoperative increased Qmax (MD 2.54; 95% CI 1.02-4.05; P = 0.001) were better in TURP than in PAE; however, PAE was associated with lower sexual dysfunction rate (OR 0.24; 95% CI 0.15-0.39; P < 0.00001) compared with TURP. Meanwhile, no significant difference in postoperative reduced PVR (MD 0.46; 95% CI - 2.08 to 3.00; P = 0.72) and complication (OR 0.57; 95% CI 0.21-1.55; P = 0.27) between PAE and TURP group was demonstrated. CONCLUSION: PAE was inferior to TURP in the improvement of postoperative IPSS, QOL, PV, Qmax and TURP still remained the gold standard. However, PAE may be a valuable alternative to TURP in the treatment of BPH patients who refuse surgery or with surgery contraindication.

Semi-automatic prostatic artery detection using cone-beam CT during prostatic arterial embolization.

BACKGROUND: Due to the broad variability of the prostatic artery (PA), its origin, small calibers, and tortuous courses, prostatic arterial embolization (PAE) is challenging, time-consuming, and results in high radiation doses. PURPOSE: To evaluate the accuracy of PA detection using cone-beam computed tomography (CBCT) performed from the aortic bifurcation in combination with a semi-automatic detection software in comparison to oblique view digital subtraction angiography (DSA) with internal iliac artery (IIA) injection. MATERIAL AND METHODS: Twenty-two consecutive patients were included in this retrospective, IRB-approved study between July and December 2017. CBCT from the aorta and 30° oblique-view DSA from both IIAs were obtained for PA detection. Results of suggested PAs from the semi-automatic vessel detection software after CBCT and IIA DSA were compared. Moreover, dose area product (DAP) was recorded. Statistical analysis included Spearman's correlation, Mann-Whitney U test, and the Wilcoxon test considering P<0.05 as significant. RESULTS: PA type was classified significantly better with CBCT compared to DSA (P=0.047). In IIA DSA, PAs could not be identified in 18% on the left and in 17% on the right side. CBCT detected all PAs, although truncation occurred in 59% because of the limited field of view. Mean DAP of the whole procedure was 257,161.32±127,909.36 mGy*cm2. Mean DAPs were for a single DSA 14,502.51±9,437.67 mGy*cm2 and for one CBCT 15,589.23±2,722.49 mGy*cm2. A mean of 14.82 DSAs and only one CBCT were performed. CBCT accounted for 6% and DSA for 84% of the entire DAP of the procedure. CONCLUSION: CBCT with semi-automatic feeding vessel detection software detects PAs more accurately than IIA DSA and may reduce radiation dose.

[Surgical treatment of BPO: Standard and innovations]. / Traitements chirurgicaux de l'obstruction prostatique bénigne : standards et innovations.

INTRODUCTION AND OBJECTIVE: Surgical management of benign prostatic hyperplasia has dramatically changed in the recent years towards higher proportion of endoscopic treatment and fewer perioperative complications. Nevertheless the question of urinary and sexual quality of life after surgical treatment remains partially unresolved with a high proportion of retrograde ejaculation after conventional surgical treatments. Therefore mini-invasive alternatives to conventional surgery have been proposed. The objective of this literature review was to provide an overview of the alternatives to monopolar TURP currently available in France. MATERIAL AND METHOD: A non-systematic review of the scientific literature was conducted from the PubMed database to retrieve the most relevant scientific publications. A first research was cross-referenced with the results of literature reviews already published and enriched by the authors of this review. A synthesis is proposed for each alternative technique mentioning its level of clinical development, but also its potential advantages and disadvantages compared to conventional surgical techniques. RESULTS: The quality of life of patients after surgical or interventional management has become the main priority of urologists since the risks of perioperative complication have been reduced by the use of laser or bipolar endoscopic techniques. Thanks to the development of minimally invasive alternatives that are better and better evaluated by randomized trials versus interventional simulation and conventional surgical treatment, more personalized care is possible. Patients' expectations and their individual risk factors can thus be placed at the center of the therapeutic decision and the preoperative information. CONCLUSION: The surgical and interventional management of LUTS due to BPH has evolved to lower perioperative morbidity with the help of numerous technological developments. Mini-invasive alternatives to standard treatment have also been proposed in order to improve the quality of postoperative sexual life. These alternatives provide significant improvement in LUTS that remains lower than after conventional treatments. Somme of these alternative are also not fully supported by clinical trials, which should urge urologists to act with caution when proposing these alternatives in daily clinical practice.

Benign prostatic hyperplasia after prostatic arterial embolization in a canine model: A 3T multiparametric MRI and whole-mount step-section pathology correlated longitudinal study.

PURPOSE: To explore the morphological and functional characteristics of prostatic arterial embolization (PAE) in a canine model of benign prostatic hyperplasia (BPH) with 3T multiparametric magnetic resonance imaging (mp-MRI) and whole-mount step-section pathology correlation. MATERIALS AND METHODS: Eight adult male beagle dogs with hormone-induced BPH underwent 3T mp-MRI before and 1, 3, and 6 months after PAE, with subsequent whole-mount step-section pathologic assessment. Images were acquired using T1 -weighted images (T1 WI), T2 WI, 3D-SPACE, diffusion-weighted imaging (DWI), susceptibility-weighted imaging (SWI), T2 -mapping, and dynamic contrast-enhanced (DCE) sequences. Variance analysis was performed to assess statistical differences in prostatic volume (PV), apparent diffusion coefficient (ADC), and T2 values. Pearson correlation analysis was performed to correlate ADC, T2 , and PV. RESULTS: The PV decreased from baseline to 1, 3, and 6 months after PAE from (25.88 ± 7.09) cm3 to (6.48 ± 2.08) cm3 , (6.48 ± 3.39) cm3 , (6.20 ± 2.88) cm3 . The ADC values sequentially decreased from baseline to 1, 3, and 6 months after PAE from (1497.06 ± 222.72) × 10-6 mm2 /s to (1056.00 ± 189.46) × 10-6 mm2 /s, (950.48 ± 77.85) × 10-6 mm2 /s, (980.98 ± 107.78) × 10-6 mm2 /s. The T2 values decreased from baseline to 1, 3, and 6 months after PAE were (83.74 ± 5.29) msec, (68.72 ± 5.66) msec, (53.96 ± 15.04) msec, (49.81 ± 13.34) msec, respectively. ADC and T2 values were positively correlated with PV (r = 0.823 and 0.744, respectively). Microhemorrhages and hemosiderin were found on SWI after PAE. CONCLUSION: 3T mp-MRI may facilitate noninvasive assessment of morphological and functional changes of BPH after PAE. LEVEL OF EVIDENCE: 1 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2017;46:1220-1229.

Prostatic Arterial Embolization Followed by Holmium Laser Enucleation of the Prostate as a Planned Combined Approach for Extremely Enlarged Benign Prostate Hyperplasia.

OBJECTIVE: This study was aimed at reporting the initial experience with prostatic arterial embolization (PAE) followed by holmium laser enucleation of the prostate (HoLEP) as a planned combined approach for extremely enlarged benign prostate hyperplasia (BPH), and retrospectively estimating the efficacy and safety of this novel technique. PATIENTS AND METHODS: Twenty-four BPH patients who underwent PAE and subsequent HoLEP were included. The PAE procedure was performed under local anesthesia at the supine position with polyvinyl alcohol spherical particles and gelatin sponge particles. HoLEP was performed 3 months after PAE by the "en-bloc" enucleation technique. Clinical data before and 6 months after the procedure were analyzed. RESULTS: PAE and HoLEP were technically successful in all 24 patients. The mean prostate volume was 219 ± 38 mL; the mean total operative time and enucleation time for HoLEP were 117.8 ± 21.9 and 83.5 ± 15.4 min, respectively; and the mean resected prostate weight was 118.3 ± 20.7 g. No transurethral resection of the prostate syndrome was observed during and after HoLEP. The estimated blood loss during HoLEP was 72.1 ± 33.7 mL, and no case required transfusion. International Prostate Symptom Score and post void residual volume decreased significantly (24.1 ± 2.84 vs. 13.5 ± 3.39, p < 0.001; 107.1 ± 40.8 vs. 21.8 ± 16.8, p < 0.001, respectively), maximal flow rate increased significantly (6.25 ± 1.42 vs. 17.63 ± 16.56, p < 0.001), and prostatic specific antigen level also decreased after the procedure (9.29 ± 2.28 vs. 4.99 ± 1.35, p < 0.001). CONCLUSIONS: PAE followed by HoLEP as a planned combined approach can be performed safely, feasibly, and efficiently in patients with extremely enlarged BPH.

Cadaveric and radiologic study of the anatomical variations of the prostatic arteries: A review of the literature and a new classification proposal with application to prostatectomy.

Development of prostatic arterial embolization (PAE) to treat benign prostatic hyperplasia (BPH) has raised interest in the variations of the prostatic arteries (PA). The aim of this study is to identify these vascular variations, to compare them with previous data, and to propose a simple classification. Ten adult male pelvis sides from embalmed cadavers were dissected, ages 69 to 92 years, and 10 PA were examined. In a retrospective analysis of 34 DSA pelvic angiographies on 28 patients aged 50 to 90 years, 48 PA were identified. A total of 58 PA were therefore analyzed. Six types are defined. Type I: PA originates from the anterior division (AD) of the internal iliac artery (IIA), 20.7%; Type II: PA emerges from the obturator artery (OA), 5.2%; type III: PA arises from the gluteal-pudendal trunk (GPT), 27.5%; Type IV: PA originates from the internal pudendal artery (IPA), 29.3%; Type V: PA comes from the middle rectal artery (MRA), 15.5%. Other origins, not observed in our sample but described in the literature, were amalgamated under Type VI. The AD/GPT/IPA stem is the main source of the PA. Analysis of the definitions of IIA branches and the associated terminology is necessary for interpreting the results reported by several authors on different samples, but in general the results fit the meta-analysis well. A new, simple, and complete classification for vascular variations of the PA is proposed. Clin. Anat. 30:71-80, 2017. © 2016 Wiley Periodicals, Inc.

Prostatic arterial embolization for the treatment of lower urinary tract symptoms caused by benign prostatic hyperplasia: a comparative study of medium- and large-volume prostates.

OBJECTIVES: To compare the outcomes of prostatic arterial embolization (PAE) in treating large (>80 mL) in comparison with medium-sized prostate glands (50-80 mL) to determine whether size affects the outcome of PAE. PATIENTS AND METHODS: A total of 115 patients (mean age 71.5 years) diagnosed with lower urinary tract symptoms (LUTS) attributable to benign prostatic hyperplasia (BPH) refractory to medical treatment underwent PAE. Group A (n = 64) included patients with a mean prostate volume of 129 mL; group B (n = 51) included patients with a mean prostate volume of 64 mL. PAE was performed using 100-µm particles. Follow-up was performed using the International Prostate Symptom Score (IPSS), quality of life (QoL), peak urinary flow rate (Qmax ), post-void residual urine volume (PVR), the International Index of Erectile Function short form (IIEF-5), prostate-specific antigen (PSA) and prostate volume measured by magnetic resonance imaging at 1, 3 and 6 months, and every 6 months thereafter. RESULTS: There were no significant differences between groups in baseline IPSS, QoL, Qmax , PVR, PSA level or IIEF-5 score. The technical success rate was 93.8% in group A and 96.8% in group B (P = 0.7). A total of 101 patients (55 patients in group A and 46 patients in group B) completed the mean (range) follow-up of 17 (12-33) months. Compared with baseline, there were significant improvements in IPSS, QoL, Qmax , prostate volume and PVR in both groups after PAE. The outcomes in group A were significantly better than in group B with regard to mean ± sd IPSS (-14 ± 6.5 vs -10.5 ± 5.5, respectively), Qmax (6.0 ± 1.5 vs 4.5 ± 1.0 mL/s, respectively), PVR (-80.0 ± 25.0 vs -60.0 ± 20.0 mL, respectively), prostate volume (-54.5 ± 18.0 mL [-42.3%] vs -18.5 ± 5.0 mL [-28.9%], respectively), and QoL score (-3.0 ± 1.5 vs -2.0 ± 1.0) with P values <0.05. The mean IIEF-5 score was not significantly different from baseline in both groups. No major complications were noted. CONCLUSIONS: We found that PAE is a safe and effective treatment method for patients with LUTS attributable to BPH. The clinical and imaging outcomes of PAE were better in patients with larger prostate glands than medium-sized ones.

Early results and complications of prostatic arterial embolization for benign prostatic hyperplasia.

PURPOSE: To review current knowledge on clinical outcomes and peri-operative complications of prostatic arterial embolization (PAE) in patients treated for lower urinary tract symptoms (LUTS) related to benign prostatic obstruction (BPO). METHODS: A systematic review of the literature published from January 2008 to January 2015 was performed on PubMed/MEDLINE. RESULTS: Fifty-seven articles were identified, and four were selected for inclusion in this review. Only one randomized clinical trial compared transurethral resection of the prostate (TURP) to PAE. At 3 months after the procedure, mean IPSS reduction from baseline ranged from 7.2 to 15.6 points. Mean urine peak-flow improvement ranged from +3.21 ml/s to +9.5 ml/s. When compared to TURP, PAE was associated with a significantly lower IPSS reduction 1 and 3 months after the procedure. A trend toward similar symptoms improvement was however reported without statistical significance from 6 to 24 months. Major complications were rare with one bladder partial necrosis due to non-selective embolization. Mild adverse events occurred in 10 % of the patients and included transient hyperthermia, hematuria, rectal bleeding, painful urination or acute urinary retention. Further comparative studies are mandatory to assess post-operative rates of complications, especially acute urinary retention, after PAE and standard procedures. CONCLUSION: Early reports suggest that PAE may be a promising procedure for the treatment of patients with LUTS due to BPO. However, the low level of evidence and short follow-up of published reports preclude any firm conclusion on its mid-term efficiency. Further clinical trials are warranted before any use in clinical practice.

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

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.

Human cadaveric specimen study of the prostatic arterial anatomy: implications for arterial embolization.

PURPOSE: To describe and illustrate the prostatic arterial anatomy from human cadaveric specimens, highlighting implications for prostatic arterial embolization. MATERIALS AND METHODS: Dissection of 18 male pelves from white adults 35-68 years old was performed in the anatomy laboratory. Arterial branches were identified according to standard dissection technique using a 20-diopter magnifying lens for the prostatic sector. The branches were colored with red acrylic paint to enhance contrast and improve visualization. RESULTS: Two main arterial pedicles to the prostate from each hemipelvis were identified in all cadaveric specimens: the superior and inferior prostatic pedicles. The superior prostatic pedicle provides the main arterial supply of the gland and provides branches to both the inferior bladder and the ejaculatory system. The inferior prostatic pedicle distributes as a plexus in the prostatic apex and anastomoses with the superior pedicle. This pattern of prostatic arterial distribution was constant in all cadaveric specimens. In contrast, the origin of the superior prostatic pedicle was variable from different sources of the internal iliac artery. CONCLUSIONS: The description and illustration of the prostatic arterial anatomy, as demonstrated by this cadaveric study, may provide useful information and guidance for prostatic arterial embolization.

Does polyvinyl alcohol particle size change the outcome of prostatic arterial embolization for benign prostatic hyperplasia? Results from a single-center randomized prospective study.

PURPOSE: To evaluate whether different polyvinyl alcohol (PVA) particle sizes change the outcome of prostatic arterial embolization (PAE) for benign prostatic hyperplasia (BPH). MATERIALS AND METHODS: A randomized prospective study was undertaken in 80 patients (mean age, 63.9 y; range, 48-81 y) with symptomatic BPH undergoing PAE between May and December 2011. Forty patients underwent PAE with 100-µm (group A) and 200-µm PVA particles (group B). Visual analog scales were used to measure pain, and rates of adverse events were recorded. PAE outcomes were evaluated based on International Prostate Symptom Score (IPSS) and quality-of-life (QoL) questionnaires, prostate volume (PV), prostate-specific antigen (PSA) levels, and peak flow rate measurements at baseline and 6 months. RESULTS: No differences between groups regarding baseline data, procedural details, or adverse events were noted. Mean pain scores were as follows: during embolization, 3.2 ± 2.97 (group A) versus 2.93 ± 3.28 (group B); after embolization, 0.10 ± 0.50 (group A) versus 0 (group B; P = .20); and the week after PAE, 0.85 ± 1.65 (group A) versus 0.87 ± 1.35 (group B; P = .96). Patients in group B had greater decreases in IPSS (3.64 points; P = .052) and QoL (0.57 points; P = .07). Patients in group A had a greater decrease in PV (8.75 cm(3); P = .13) and PSA level (2.09 ng/mL; P < .001). CONCLUSIONS: No significant differences were found in pain scores and adverse events between groups. Whereas PSA level and PV showed greater reductions after PAE with 100-µm PVA particles, clinical outcome was better with 200-µm particles.

Influence of benign prostatic hyperplasia patterns detected with MRI on the clinical outcome after prostatic artery embolization.

BACKGROUND: To investigate the influence of benign prostatic hyperplasia (BPH) patterns detected with MRI on clinical outcomes after prostatic artery embolization (PAE). MATERIALS & METHODS: This retrospective study included 71 consecutive patients with lower urinary tract symptoms (LUTS), who underwent magnetic resonance imaging (MRI) of the prostate followed by PAE at a single centre. MRI scans were evaluated and BPH patterns were determined according to Wasserman type and a modified BPH classification. Additionally, scans were evaluated regarding the presence of adenomatous-dominant benign prostatic hyperplasia (AdBPH). LUTS were assessed using the International Prostate Symptom Score (IPSS) and urinary flow rate (Qmax). Follow-up examination included MRI and clinical outcome. RESULTS: For clinical outcome at follow-up, IPSS showed median reduction of 54% (IQR 41-75%) and Qmax improved by 4.1 ml/s. We noted significant reduction in volume, intraprostatic protrusion, and prostatic urethral angle in our collective (p < 0.01). Median volume reduction was 25% (IQR 15%-34%). Bilateral embolization was a significant predictor for volume reduction at follow-up. Multiple linear regression analysis showed significant effect of high initial volume on reduction in IPSS after treatment (p < 0.01). Presence of AdBPH was significantly associated with both, volume loss and clinical improvement in terms of IPSS reduction (p < 0.01). Neither BPH pattern based on the Wassermann type nor modified BPH classification were significantly related with postinterventional IPSS and volume loss. CONCLUSIONS: Men benefit from PAE regardless the macroscopic BPH MRI pattern. Preinterventional prostate volume and presence of AdBPH on MRI should be considered for outcome prognosis after PAE.

Imaging patterns of the arterial supply of the prostate gland in adult Ghanaian men.

Background: Prostatic arterial embolization (PAE) is a novel procedure in West Africa and Ghana. A thorough understanding of the prostate artery's (PA) anatomy and pattern is required for successful prostatic arterial embolization and to guarantee targeted intervention. This study focuses on prostate arterial supply in adult males, including prevalence, variability, and imaging pattern. Methodology: A prospective cross-sectional study was conducted, at Euracare Advanced Diagnostics and Heart Centre. Patients who presented for Computed Tomography Angiography of the pelvis were included in the study. A total of 52 males were included and 104 pelvic CT angiography (one for each side) were analyzed, including: prostatic artery diameter, prostatic gland volume and prostate artery branching pattern. The PA branching pattern was classified using de Assis et al. classification. Result: Thirty-seven (71.15%) men had enlarged prostate volume (>30ml). On each side there was only one prostatic artery and no accessory one was found. Only three types of arterial branching were identified: type I, II,III. The type I artery was the most common origin 58.7% (61/104). PA originating from the anterior division of the internal iliac artery (type II) and the type III is from the internal pudendal artery, accounted for 16.3% (17/104) and 25% (26/104) respectively. Conclusion: The most frequent type of PA origin was type I followed by type III then II. Knowing the different and most frequent types of anatomy of PA may help standardization and effectiveness of the PAE in developing countries.

Epirubicin-loaded beads transarterial prostatic arterial chemoembolization is a promising treatment for advanced prostate cancer with lower urinary tract obstruction or hematuria-a case series report.

Background: Prostatic arterial embolization (PAE) is an effective minimally invasive treatment for lower urinary tract obstruction and hematuria in patients with benign prostatic hyperplasia (BPH). This study was aim to evaluate the safety and short-term efficacy of drug epirubicin-loaded beads transarterial prostatic arterial chemoembolization (DEB-PACE) for the treatment of advanced prostate cancer (PC) with lower urinary tract obstruction or hematuria. Methods: A total of 8 patients with advanced PC undergoing DEB-PACE from August 2020 to February 2022 were retrospectively enrolled. The patients were followed up at 1 week, 1, 3, 6 and 12 months after DEB-PACE. The origin of prostatic arteries, technical success, clinical success rate, duration of the indwelling urinary catheter, International Prostate Symptom Score (IPSS), QoL score (quality of life), prostate volume (PV), prostate-specific antigen (PSA) level and complications were recorded. The short-term efficacy (changes in IPSS, PV and QoL value from baseline to 3 months) were analysed. Results: There were 17 prostatic arteries in 8 patients, which mainly originated from internal pudendal artery (11/17, 64.7%), the technical success rate is 100%. After treatment, the symptoms of lower urethral obstruction in 8 patients were significantly improved that PSA, PV, IPSS and QoL level were significantly reduced. The catheter was successfully removed within 1 week on average, and 2 patients with hematuria disappeared within 5 days. The clinical success rate is 100%. At 1 month postoperatively, mean PV reduction was 30.28±6.963 cm3 (P=0.0457), mean IPSS reduction was 21.13±2.887 points (P=0.0042), mean QoL reduction was 3.75±0.366 points (P=0.006). At 3 months postoperatively, mean PV reduction was 46.14±8.906 cm3 (P=0.0112), mean IPSS reduction was 24.5±2.398 points (P=0.0003), mean QoL reduction was 4.25±0.25 points (P=0.0003). There were no serious complications occurred in all patients. Conclusions: DEB-PACE is a promising treatment for advanced PC with lower urinary tract obstruction or hematuria. However, the efficacy and safety of DEB-PACE for advanced PC is needed to validated by prospective large sample randomized controlled study.

Effect of superselective prostatic artery embolization on benign prostatic hyperplasia.

PURPOSE: To investigate the safety and effectiveness of superselective prostatic artery embolization (PAE) in patients with benign prostatic hyperplasia (BPH). METHODS: Sixty-five patients diagnosed with BPH in Fujian Provincial Hospital between December 2014 and July 2019 were included. Patients with ineffective drug treatment after 6 months, who refused surgery, or who were unsuitable for surgery were included. We observed postoperative complications, followed up at 1, 3, and 6 months, compared clinical symptoms, and monitored changes in prostate-specific antigen (PSA) and prostatic volume (PV) before and after treatment. RESULTS: Of the 65 patients, 58 (89.23%) successfully received PAE; 44 and 14 bilateral and unilateral embolization, respectively. Clinical efficacy was 94.83% (55/58) after the 6-month follow-up. Postoperative PV, International Prostate Symptom Score, quality of life, maximum flow rate, and post-void residual significantly improved after 6 months (P < 0.05). One month after PAE, the serum total PSA increased by 1.47 (10.84/7.37) times and dropped 3 months later to a level lower than that before surgery (P < 0.05). Six months after PAE, the degree of relief from obstructive symptoms was more apparent than that of irritative symptoms. No serious complications were observed after PAE. CONCLUSION: PAE was safe and effective for the treatment of BPH. The efficacy of bilateral PAE was better than that of unilateral PAE.

Prostatic Arterial Embolization Treating Moderate-to-Severe Lower Urinary Tract Symptoms Related to Benign Prostate Hyperplasia: A Meta-Analysis.

PURPOSE: To evaluate the clinical efficiency and safety of PAE treating moderate-to-severe LUTS related to BPH. MATERIALS AND METHODS: A systematic literature search was performed using PUBMED, EMBASE, Cochrane database of systematic review, and Web of Science, up to April 2016, to identify eligible studies. The Cochrane Collaboration's RevMan 5.3 was used to analyze the extracted data. Random- or fixed-effect model was selected to fit the pooled out heterogeneity. RESULTS: 20 eligible studies were included in this meta-analysis. Synthetic data showed that there were statistically significant improvements in IPSS (MD = -13.25; 95% CI -14.81 to -11.69; P < 0.00001), QoL score (MD = -2.34; 95% CI -2.69 to -2.00, P < 0.00001), PSA level (MD = -1.33; 95% CI -1.86 to -0.80; P < 0.00001), PV (MD = -28.00; 95% CI -35.94 to -20.07; P < 0.00001), Qmax (MD = 5.51; 95% CI 4.62 to 6.40; P < 0.00001), and PVR (MD = -67.8; 95% CI -81.35 to -53.60; P < 0.00001). There was no significant difference in IIEF score (MD = 0.93; 95% CI 0.43-1.42; P = 0.07). Major complications following PAE include pain in the perineum, retropubic area, and/or urethra (9.4%), and hematuria (9.0%). CONCLUSIONS: PAE should be considered to be the very promising alternative treatment for those who do not want or cannot tolerate surgical treatment, with its benefits on IPSS, QoL score, PSA level, PV, Qmax, and PVR without affecting erectile function.

The application of C-arm CT scan in performing precise prostatic arterial embolization / 介入放射学杂志

Objective To discuss the application of C-arm CT scan in performing precise prostatic arterial embolization (PAE).Methods The dominant artery of the prostate and its spatial relationship with the peripheral blood vessels were identified by intraoperative synchronous XperCT angiography,which was followed by the performance of precise PAE.Results Among 16 patients with benign prostatic hyperplasia,one patient had to give up the operation because abdominal aortic aneurysm was found by intraoperative angiography;2 patients received unilateral precise PAE as contralateral internal iliac artery was occluded;bilateral precise PAE was successfully accomplished in 13 patients.XperCT angiography was successfully performed for all the arteries that were treated with embolization.Based on the contrast agent staining of the prostate gland and the 3D reconstruction of peripheral arteries,the dominant artery of the prostate and its spatial relationship with the peripheral blood vessels were determined,and precise PAE was carried out.After PAE,no ectopic embolism-related complications occurred.One month after PAE,the remission rate of clinical symptoms was 100％.Conclusion Intraoperative C-arm CT scan can provide more accurate images which are very important for accurately identifying the prostate arteries and its relationship with the peripheral vessels,therefore,C-arm CT scan is an important technical support for the performance of precise PAE.