EAU 2018: Our Experience And Actual Indications For Prostatic Artery Embolization As An Alternative Treatment For Lower Urinary Tract Symptoms
Dr. Secco of the ASST Grande Ospedale Metropolitano Niguarda Department of Urology in Milan, Italy presents a prospective cohort study to assess the efficacy and safety of PAE in relieving LUTS in patients with BPH and BPO.
186 PAE patients were prospectively enrolled from November 2013 through April 2017. All patients had a MRI or CT study, a diagnosis of LUTS assumed to be due to BPO or BPH, and had attempted prior treatment via intermittent catheterization or pharmaceutical management to no effect. All patients were also considered unfit for surgical interventions, due to other comorbidities, as assessed by a third party anesthesiologist.
Among the 186 PAE performed, the median age of patients was 72.4 years, with a median Charlson Comorbidity Index was 5.27 (range 2-14). While PAE was technically successful in 151 (81.2%) patients, 99 complained of urethral burning in the first 48 hours after the procedure and the catheter was not removed until 15 days after the procedure.
In this cohort, over half of the patients (96 or 51.6%) did not have an indwelling catheter (IC). Of the non-IC patients, 27 had urgency and frequency for 10 days post-catheter removal. Uroflowmetry demonstrated a significant improvement in mean Qmax (p<0.01) and visual scale confirmed an improvement in quality of life (p<0.01).
Overall, the present study confirmed both the feasibility and safety in addition to the technical success of PAE in the management of patients otherwise unsuitable for surgical intervention of BPH or BPO. Of note, the surgical procedure was most beneficial for patients (in terms of quality of life and uroflowmetry) who were previously treated via intermittent catheterization or indwelling catheters. As such, should be considered and discussed as an option for patients who have significant medical histories that prevent other surgical treatments.
Authors: Secco S. 1 , Barbosa F. 2 , Di Trapani D. 1 , Brambillasca P.M. 2 , Barbieri M. 1 , Migliorisi C. 2 , Napoli G. 1 , Vercelli R. 2 , Solcia M. 2 , Petralia G. 1 , Strada E. 1 , Bocciardi A. 1 , Rampoldi A. 2 , Galfano A. 1
Written by: Linda M. Huynh, B.S., University of California-Irvine, at the 2018 European Association of Urology Meeting EAU18, 16-20 March, 2018 Copenhagen, Denmark