Prostatic artery embolization as a primary treatment for benign prostatic hyperplasia: preliminary results in two patients.
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-alpha-reductase inhibitors and selective alpha-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-microm 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.
Carnevale
Francisco Cesar
FC
Interventional Radiology Unit, Radiology Institute, Hospital das Clinicas, University of Sao Paulo Medical School, Av. Dr. Enéas de Carvalho Aguiar, 255, Sao Paulo, SP 05403-001, Brazil. fcarnevale@uol.com.br
Antunes
Alberto Azoubel
AA
da Motta Leal Filho
Joaquim Mauricio
JM
de Oliveira Cerri
Luciana Mendes
LM
Baroni
Ronaldo Hueb
RH
Marcelino
Antonio Sergio Zafred
AS
Freire
Geraldo Campos
GC
Moreira
Airton Mota
AM
Srougi
Miguel
M
Cerri
Giovanni Guido
GG
D000208:Acute Disease; D000368:Aged; D001158:Arteries; D001707:Biopsy, Needle; D004621:Embolization, Therapeutic / Q000379:methods*; D019160:Endosonography / Q000379:methods; D005500:Follow-Up Studies; D006801:Humans; D007150:Immunohistochemistry; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D011467:Prostate / Q000098:blood supply*; D011470:Prostatic Hyperplasia / Q000150:complications / Q000175:diagnosis* / Q000628:therapy*; D018570:Risk Assessment; D016896:Treatment Outcome; D014546:Urinary Catheterization / Q000379:methods; D016055:Urinary Retention / Q000209:etiology / Q000628:therapy*