title: Prostatic Artery Embolization as an Alternative to Indwelling Bladder Catheterization to Manage Benign Prostatic Hyperplasia in Poor Surgical Candidates.
abstract: OBJECTIVE
  To prospectively assess discontinuation of indwelling bladder catheterization (IBC) and relief of lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH) following prostate artery embolization (PAE) in poor surgical candidates.
  
  
  METHODS
  Patients ineligible for surgical intervention were offered PAE after at least 1 month of IBC for management of urinary retention secondary to BPH; exclusion criteria for PAE included eligibility for surgery, active bladder cancer or known prostate cancer. Embolization technical and clinical success were defined as bilateral prostate embolization and removal of IBC, respectively. Patients were followed for at least 6 months and evaluated for International Prostate Symptom Score, quality of life, prostate size and uroflowmetric parameters.
  
  
  RESULTS
  A total of 43 patients were enrolled; bilateral embolization was performed in 33 (76.7%), unilateral embolization was performed in 8 (18.6%), and two patients could not be embolized due to tortuous and atherosclerotic pelvic vasculature (4.7%). Among the patients who were embolized, mean prostate size decreased from 75.6 ± 33.2 to 63.0 ± 23.2 g (sign rank p = 0.0001, mean reduction of 19.6 ± 17.3%), and IBC removal was achieved in 33 patients (80.5%). Clavien II complications were reported in nine patients (21.9%) and included urinary tract infection (three patients, 7.3%) and recurrent acute urinary retention (six patients, 14.6%). Nine patients (22.0%) experienced post-embolization syndrome.
  
  
  CONCLUSIONS
  PAE is a safe and feasible for the relief of LUTS and IBC in highly comorbid patients without surgical treatment options.
authors.affiliation: Department of Interventional Radiology, Ospedale Niguarda Ca' Granda, Piazza Ospedale Maggiore, 3, 20100, Milan, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Rampoldi
authors.affiliation: Department of Interventional Radiology, Ospedale Niguarda Ca' Granda, Piazza Ospedale Maggiore, 3, 20100, Milan, Italy. fabiane001@hotmail.com.
authors.forename: Fabiane
authors.identifier: http://orcid.org/0000-0002-9533-354X
authors.initials: F
authors.lastname: Barbosa
authors.affiliation: Department of Urology, Ospedale Niguarda Ca' Granda, Piazza Ospedale Maggiore, 3, 20100, Milan, Italy.
authors.forename: Silvia
authors.initials: S
authors.lastname: Secco
authors.affiliation: Department of Interventional Radiology, Ospedale Niguarda Ca' Granda, Piazza Ospedale Maggiore, 3, 20100, Milan, Italy.
authors.forename: Carmelo
authors.initials: C
authors.lastname: Migliorisi
authors.affiliation: Department of Urology, Ospedale Niguarda Ca' Granda, Piazza Ospedale Maggiore, 3, 20100, Milan, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Galfano
authors.affiliation: Department of Urology, Ospedale Niguarda Ca' Granda, Piazza Ospedale Maggiore, 3, 20100, Milan, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Prestini
authors.affiliation: The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth-Hitchcock Medical Center, 1 Medical Center Drive, Lebanon, NH, 03756, USA.
authors.forename: Sardis Honoria
authors.initials: SH
authors.lastname: Harward
authors.affiliation: Department of Urology, Ospedale Niguarda Ca' Granda, Piazza Ospedale Maggiore, 3, 20100, Milan, Italy.
authors.forename: Dario
authors.initials: D
authors.lastname: Di Trapani
authors.affiliation: Department of Interventional Radiology, Ospedale Niguarda Ca' Granda, Piazza Ospedale Maggiore, 3, 20100, Milan, Italy.
authors.forename: Pietro Maria
authors.initials: PM
authors.lastname: Brambillasca
authors.affiliation: Department of Interventional Radiology, Ospedale Niguarda Ca' Granda, Piazza Ospedale Maggiore, 3, 20100, Milan, Italy.
authors.forename: Vercelli
authors.initials: V
authors.lastname: Ruggero
authors.affiliation: Department of Interventional Radiology, Ospedale Niguarda Ca' Granda, Piazza Ospedale Maggiore, 3, 20100, Milan, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Solcia
authors.affiliation: Department of Interventional Radiology, University of Sao Paulo Medical School, Av. Dr. Enéas de Carvalho Aguiar, 255, Sao Paulo, SP, 05403-001, Brazil.
authors.forename: Francisco Cesar
authors.initials: FC
authors.lastname: Carnevale
authors.affiliation: Department of Urology, Ospedale Niguarda Ca' Granda, Piazza Ospedale Maggiore, 3, 20100, Milan, Italy.
authors.forename: Aldo Massimo
authors.initials: AM
authors.lastname: Bocciardi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002404:Catheterization; D015331:Cohort Studies; D004621:Embolization, Therapeutic / Q000379:methods*; D006801:Humans; D059411:Lower Urinary Tract Symptoms / Q000150:complications / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011470:Prostatic Hyperplasia / Q000150:complications / Q000628:therapy*; D011788:Quality of Life; D016896:Treatment Outcome
keywords: Acute urinary retention; Benign prostatic hyperplasia; Indwelling bladder catheterization; Lower urinary tract symptoms; Prostatic artery embolization