Prostate Artery Embolization for Hematuria of Prostatic Origin: A Retrospective Review

To evaluate the safety and efficacy of prostate artery embolization (PAE) for treating hematuria of prostatic origin and investigate whether etiology and PAE’s technical variations influence treatment success.

Materials and Methods:

After IRB approval, 36 patients who underwent PAE for gross hematuria of prostatic origin from 02/2014-07/2024 at a single academic institution were retrospectively reviewed. Mean follow up was 11.5  ± 18.8 mos. The most common causes of hematuria included prostatic varices (9), traumatic catheterization (9), friable prostate (8), and post-surgical bleeds (7). Inter-proceduralist technical variations included use of pre-procedural CTA pelvis, PErFecTED technique, and primary embolic types. All PAEs were performed with cone-beam CTs. The primary outcome was resolution of hematuria after PAE, with secondary outcome of improvement in associated lower urinary tract symptoms (LUTS). Logistic and linear regressions were used to assess associations with binary and continuous outcomes.

Results:

Of 35 patients who received embolization (one could not be treated due to inability to cannulate prostate arteries bilaterally), 31 (88.6%) had complete resolution of hematuria, with 6 (19.4%) having recurrence at 32.7 ± 24.7 mos after PAE. 31 patients had concurrent LUTS, of whom 15 were foley-dependent and 2 required intermittent catheterizations (ISC). 14 foley-dependent patients subsequently underwent voiding trials and 9 (60%) were catheter free after a mean of 6.1 months. Both ISC patients were able to stop catheterizations at an average of 4.4 months. All 8 non-foley dependent patients with LUTS and International Prostate Symptoms Scores (IPSS) experienced symptomatic improvement with IPSS decreasing from 18.0± 8.8 to 10.8 ± 6.2 by 3 months post-procedure (p = .002). Radiation dose required for PAE was noted to decrease at an average of 277mGy/year (CI: 118-436 mGy; p = 0.017), while fluoroscopy time increased with increasing number of treated branches at an average of 18 min/branch (CI: 7.4-28 min; p = 0.028). Hematuria etiology and technical variations did not affect technical or treatment success. 14 patients (36.1%) reported temporary post-embolization syndrome that resolved with medications. There were no major adverse events.

Conclusion:

PAE is safe and effective for treating hematuria of prostatic origin. For patients with associated LUTS, PAE may also reduce IPSS and potentially allow patients with urinary retention to become catheter-free. Further controlled, multi-center studies with larger patient populations and longer follow-up are needed.