title: Recurrence of Lower Urinary Tract Symptoms Following Prostate Artery Embolization for Benign Hyperplasia: Single Center Experience Comparing Two Techniques.
abstract: OBJECTIVE
  To compare recurrence of lower urinary tract symptoms (LUTS) recurrence at 12 months following original prostate artery embolization (oPAE) or "proximal embolization first, then embolize distal" (PErFecTED) PAE for benign prostatic hyperplasia (BPH).
  
  
  METHODS
  105 consecutive patients older than 45 years, with prostate size greater than 30 cm3, International Prostate Symptom Score (IPSS) ≥ 8, quality of life (QoL) index ≥ 3, and refractory status or intolerance of medical management were prospectively enrolled between June 2008 and August 2013. The study was IRB-approved, and all patients provided informed consent. Patients underwent oPAE or PErFecTED PAE and were followed for at least 12 months. Technical success was defined as bilateral embolization and clinical success (non-recurrence) was defined as removal of the Foley catheter in patients with urinary retention, IPSS < 8 and QoL index < 3 at 12 months of follow-up. Nonparametric statistics were used to compare the study groups due to the size of the study population and distributions of clinical data.
  
  
  RESULTS
  97 patients had 12-month data and were categorized as oPAE without recurrence (n = 46), oPAE with recurrence (n  = 13), PErFecTED without recurrence (n  = 36), or PErFecTED with recurrence (n  = 2). Recurrence was significantly more common in oPAE patients (χ2, p = 0.026). Unilateral embolization was significantly associated with recurrence among patients who underwent oPAE (χ2, p = 0.032).
  
  
  CONCLUSIONS
  Both oPAE and PErFecTED PAE are safe and effective methods for treatment of LUTS, but PErFecTED PAE is associated with a significantly lower rate of symptom recurrence.
authors.affiliation: Department of Radiology, University of Sao Paulo, Av. Dr. Enéas de Carvalho Aguiar, 255, São Paulo, SP, 05403-001, Brazil. francisco.carnevale@criep.com.br.
authors.forename: Francisco Cesar
authors.initials: FC
authors.lastname: Carnevale
authors.affiliation: Department of Radiology, University of Sao Paulo, Av. Dr. Enéas de Carvalho Aguiar, 255, São Paulo, SP, 05403-001, Brazil.
authors.forename: Airton Mota
authors.initials: AM
authors.lastname: Moreira
authors.affiliation: The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH, USA.
authors.forename: Sardis Honoria
authors.initials: SH
authors.lastname: Harward
authors.affiliation: Department of Interventional Radiology, University of Miami Medical Center, Miami, FL, USA.
authors.forename: Shivank
authors.initials: S
authors.lastname: Bhatia
authors.affiliation: Department of Radiology, University of Sao Paulo, Av. Dr. Enéas de Carvalho Aguiar, 255, São Paulo, SP, 05403-001, Brazil.
authors.forename: Andre Moreira
authors.initials: AM
authors.lastname: de Assis
authors.affiliation: Department of Urology, University of Sao Paulo, Sao Paulo, Brazil.
authors.forename: Miguel
authors.initials: M
authors.lastname: Srougi
authors.affiliation: Department of Radiology, University of Sao Paulo, Av. Dr. Enéas de Carvalho Aguiar, 255, São Paulo, SP, 05403-001, Brazil.
authors.forename: Giovanni Guido
authors.initials: GG
authors.lastname: Cerri
authors.affiliation: Department of Urology, University of Sao Paulo, Sao Paulo, Brazil.
authors.forename: Alberto Azoubel
authors.initials: AA
authors.lastname: Antunes
mesh_terms: D000368:Aged; D015897:Comorbidity; D004621:Embolization, Therapeutic / Q000379:methods*; D005500:Follow-Up Studies; D006801:Humans; D059411:Lower Urinary Tract Symptoms / Q000453:epidemiology* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011467:Prostate / Q000098:blood supply; D011470:Prostatic Hyperplasia / Q000453:epidemiology* / Q000628:therapy*; D012008:Recurrence; D016896:Treatment Outcome; D016055:Urinary Retention
keywords: Benign prostatic hyperplasia; International Prostate Symptom Score; Lower urinary tract symptoms; Prostatic artery embolization