73 - Long-term results of Adjunctive Coil Embolization of Prostatic Artery During Prostatic Artery Embolization

Prostatic artery recanalization after prostatic artery embolization (PAE) is suggested as one of the major etiologies for recurrence of symptoms after PAE. We reasoned that coil embolization of main prostatic artery after particle embolization (Coil-Out technique) provides durable response to PAE.

Materials and Methods:

A retrospective review of a prospectively maintained PAE registry between July 2020-Dec 2023 was performed. Only PAE patients with successful bilateral PAE and adequate 2-years follow up data, with cross-sectional imaging at follow up were included. Clinical outcomes, adverse events and repeat embolization were collected and compared between coil-out technique and standard PAE. Clinical success after PAE was defined as international prostate symptom score (IPSS) improvement of 25% or quality of life pleased/delighted. P< 0.05 was considered significant. 

Results: Total of 222 patients evaluated, out of which 32 completed 2-years clinical follow-up. Mean (SD) patient age and prostate volume were 74 (8) years and 141 (99) milliliters. Age and the baseline prostate volumes were not different between coil and no-coil groups (p >0.1). Prostate volume shrinkage varied between 14% to 67%. Volume percentage shrinkage was statistically greater in coil-out group (38.5% vs. 26.6%, p=0.027).  Post embolization syndrome, erectile function, hematuria or hematospermia were similar between groups (p=0.01) with no deterioration of erectile function. At 2 years follow-up all 25 patients from coil-out group had persistently low IPSS scores. In standard PAE group (n=7) one patient required prostatectomy and one required trans-urethral resection of prostate after PAE. 

Conclusion:

Coil-Out technique is safe and results in clinical success. Volumetric analysis shows more prostate volume shrinkage with coil-out technique. At 2 years, recurrence was more in patients with standard PAE compared with coil-out PAE.