Prostatic Artery Embolization as a Primary Treatment for Benign Prostatic Hyperplasia: Preliminary Results in Two Patients

• Published in: Cardiovascular and interventional radiology 2010-04, Vol.33 (2), p.355-361
• Main Authors: Carnevale, Francisco Cesar, Antunes, Alberto Azoubel, da Motta Leal Filho, Joaquim Mauricio, de Oliveira Cerri, Luciana Mendes, Baroni, Ronaldo Hueb, Marcelino, Antonio Sergio Zafred, Freire, Geraldo Campos, Moreira, Airton Mota, Srougi, Miguel, Cerri, Giovanni Guido
• Format: Article
• Language: English
• Subjects: Acute Disease; Aged; ARTERIES; BIOLOGICAL MATERIALS; BIOLOGICAL WASTES; BIOPSY; Biopsy, Needle; BLOOD VESSELS; BODY; BODY FLUIDS; Cardiology; CARDIOVASCULAR SYSTEM; DIAGNOSTIC TECHNIQUES; DIGESTIVE SYSTEM; EMBOLI; Embolization, Therapeutic - methods; Endosonography - methods; Follow-Up Studies; GASTROINTESTINAL TRACT; GLANDS; Humans; Imaging; Immunohistochemistry; INTESTINES; LARGE INTESTINE; Magnetic Resonance Imaging - methods; Male; MALE GENITALS; MATERIALS; Medicine; Medicine & Public Health; NMR IMAGING; Nuclear Medicine; ORGANS; PROSTATE; Prostate - blood supply; Prostatic Hyperplasia - complications; Prostatic Hyperplasia - diagnosis; Prostatic Hyperplasia - therapy; Radiology; RADIOLOGY AND NUCLEAR MEDICINE; RECTUM; Risk Assessment; Technical Note; Treatment Outcome; ULTRASONOGRAPHY; Ultrasound; Urinary Catheterization - methods; Urinary Retention - etiology; Urinary Retention - therapy; URINE; WASTES
• ISSN: 0174-1551; 1432-086X
• DOI: 10.1007/s00270-009-9727-z

Symptomatic benign prostatic hyperplasia (BPH) typically occurs in the sixth and seventh decades, and the most frequent obstructive urinary symptoms are hesitancy, decreased urinary stream, sensation of incomplete emptying, nocturia, frequency, and urgency. Various medications, specifically 5-α-reductase inhibitors and selective α-blockers, can decrease the severity of the symptoms secondary to BPH, but prostatectomy is still considered to be the traditional method of management. We report the preliminary results for two patients with acute urinary retention due to BPH, successfully treated by prostate artery embolization (PAE). The patients were investigated using the International Prostate Symptom Score, by digital rectal examination, urodynamic testing, prostate biopsy, transrectal ultrasound (US), and magnetic resonance imaging (MRI). Uroflowmetry and postvoid residual urine volume complemented the investigation at 30, 90, and 180 days after PAE. The procedure was performed under local anesthesia; embolization of the prostate arteries was performed with a microcatheter and 300- to 500-μm microspheres using complete stasis as the end point. One patient was subjected to bilateral PAE and the other to unilateral PAE; they urinated spontaneously after removal of the urethral catheter, 15 and 10 days after the procedure, respectively. At 6-month follow-up, US and MRI revealed a prostate reduction of 39.7% and 47.8%, respectively, for the bilateral PAE and 25.5 and 27.8%, respectively, for the patient submitted to unilateral PAE. The early results, at 6-month follow-up, for the two patients with BPH show a promising potential alternative for treatment with PAE.