Clinical Analysis Of Super-selective Prostatic Arterial Embolization In The Treatment Of Benign Prostatic Hyperplasia

Background Benign prostatic hyperplasia(BPH)is one of the most common diseases in elder men,which has a prevalence of over 50% in men over 50 years of age and over 90%in men over 80 years of age.The initial treatment of BPH-related symptoms consists of medical management using alpha-blockers and alpha-5 reductase inhibitors.In addition to these medication,traditional Chinese medicine is also used to relieve the symptom of BPH.However,the gold standard treatment for BPH is surgical resection or transurethral prostatic resection(TURP).These treatments,even if minimally invasive such as those using radiofrequency ablation or microwave thermotherapies and other laser ablation,are not free from complications such as incontinence or urinary retention,hematuria,and sexual dysfunction(retrograde ejaculation and impotence).Therefore,there is the need for foreign and domestic doctors to continue to develop a treatment method to improve outcomes and minimise patient discomfort and morbidity when managing BPH.Prostatic arterial embolisation(PAE)for BPH has been shown to be safe and effective at inducing prostatic volume reduction and improving LUTS related to BPH in animals and humans,which is similar to the technology of uterine artery embolisation(UAE)for fibroids.As a result,PAE has been a hot area of research for urologists and interventional radiologists.However,the studies so far have been shown on few patients,short-term studies,few report of complication and security of PAE.Purpose The purpose of this study was to evaluate the effect and security of super-selective PAE for the treatment of BPH,and to provide experience for large sample application.Methods This was a prospective non-randomised study including 18 patients diagnosed with BPH and moderate to severe lower urinary tract symptoms after failure of medical treatment for at least 6 months or hard to accept the surgical treatment.All of them underwent PAE at their will between December 2014 and February 2017,Embosphere microspheres(40~120?m,100~300?m)and gelfoam(350~560?m)were used for the embolisation procedure of PAE.Technical success is when selective prostatic arterial embolisation is completed in at least one pelvic side.Clinical success was defined as improving symptoms and quality of life.Evaluation was performed before PAE and at 1,3,6 and every 6 months thereafter with the clinical symptom,postoperative reaction and complication.Moreover,International Prostate Symptom Score(IPSS),quality of life(Qo L),residual urine(RU)were included in the evaluation index.Results PAE was technically successful in all the 18 patients,the clinical success rate was100%.Among them 17 patients underwent bilateral PAE and 1 patient underwent unilateral PAE.In one artery,prostatic catheterisation was not possible because of thin and tortuosity of one prostatic artery.Digital subtraction angiography(DSA)of 22 internal iliac arteries(IIA)were finished in the 18 patients,and 38 prostatic arteries were founded during the procession.Among the 38 prostatic arteries successfully embolised,23 of them originated from inferior vesical artery,7 of them originated from internal pudendal artery,4 of them originated from obturator artery,3 of them originated from gluteal-pudendal trunk.Compared with pre-operation,clinical symptoms improved significantly 6 months after operation for the 16 patients,the rates of clinical success was 88.9%.The preoperative indexes such as IPSS was 29.56±3.01,Qo L was 5.28±0.58,RU was 123.78±66.15ml/s,1 months after operation,the above indexes of IPSS,Qo L and RU were 10.22±9.48,1.78±1.67 and 48.56±72.45ml/s,respectively.3 months after operation,the above indexes were IPSS 6.44±9.10,Qo L 0.89±1.68,RU37.50±44.39ml/s,respectively,6 months after operation,the above indexes were IPSS 5.06±8.11,Qo L 0.94±1.65,RU28.50±46.70ml/s,respectively.Compared with preoperative indexes,IPSS and Qo L after operation had significant difference(p< 0.05).One month and three months after operation,the RU had no significant difference(p=1.000,p=0.103,respectively).Six months after operation,the RU had significant difference(p=0.028).Severe postoperative complications were observed within 1 patient,present as urinary system infection,bladder and bowel dysfunction,sexual dysfunction.Edema and thickening of the the bladder wall were showed at the CT scan,the symptom present as urinary system infection and the bladder catheters was removed three weeks after procedure.Conclusions Consistent with the literature,our experience showed the feasibility,safety,efficacy and with less complication of PAE in the management of patients with LUTS related to BPH.However,the inclusion criteria and the skill of PAE should be take care.According the current literature,we should pay more attention to study the feasibility,the inclusion criteria,the complication,the long-term efficacy,the choice of embolization agent and the area should be embolized.Larger case series,longer time for follow-up and comparative studies with standard TURP or other therapies can confirm the validity of the technique.