A large longitudinal study of 1,000 patients confirmed the effectiveness and safety of prostate artery embolization (PAE) for lower urinary tract symptoms (LUTS) and urinary retention caused by benign prostatic hyperplasia (BPH), also known as prostate gland enlargement.
BPH is a common condition as men age, but as their prostate enlarges, it can lead to bothersome lower urinary tract symptoms such as feeling the constant need to urinate, waking throughout the night and developing urinary tract infections. About half of all men older than 50 have BPH, and up to 90 percent of men over age 80 have it, according to the Urology Care Foundation.
“Oftentimes, these gentlemen have increased anxiety and depression from this. They have worse sleep because they’re waking up and having to go to the bathroom in the middle of the night,” said senior author Andrew Richardson, MD, senior IR resident at Jackson Memorial Hospital in Miami. “There have been several studies that reported lower work productivity and reduced vitality. Untreated, this can lead to medical emergencies like acute urinary retention or chronic conditions like compromised kidney function and stone formation.”
The findings of “Prostate Artery Embolization-Single Center Experience of 1000 Patients with Short, Mid, and Long Term Follow Up”—which was selected as an SIR Abstract of the Year—will be presented 10:50 a.m. as part of the Closing Plenary, Hall 6 in the Phoenix Convention Center.
In this study, 1,000 men underwent PAE for either BPH with LUTS or urinary retention from January 2014 to September 2022. The mean patient age was 70.2 ± 9.5 years. Transradial access was performed in 820 procedures. The patients were evaluated at 6 to 12 months after their procedure and then at 24, 60 and 72 months.
Pre-procedure, the median International Prostate Symptom Score (IPSS) was 23, in the severe category. At 6 to 12 months, the median IPSS dropped to 6, in the mild category. Five years later, the median IPSS decreased further to 3, implying sustained long-term outcomes. At 12 months follow-up, prostate volume reduced by 33 percent, postvoid residual reduced by 60 percent and prostate-specific antigen levels reduced by 50 percent. For men with urinary retention treated with PAE, 90 percent were able to be catheter free by six months follow-up.
Postoperative symptoms, such as self-limited frequency, urgency and painful urination, occurred in 33.5 percent of patients. At some point after the initial procedure, 67 patients, or 6.7 percent, required a second procedure for recurrent LUTS; 10 underwent a second PAE.
“The key factor here is the longevity or the sustained success of these outcomes,” said presenting author Shivank Bhatia, MD, chair of the department of interventional radiology at the University of Miami Miller School of Medicine. “What we see in terms of improvement in lower urinary tract symptoms as well as relief from complete obstruction is sustained for a period of five to seven years in a very large cohort of patients, with no risk of any sexual side effects, which is very important for the patients. In comparison, many of the surgical urological procedures for BPH have side effects of either erectile or ejaculatory dysfunction or incontinence.”
