Impact of Pre-Procedure Bladder Imaging Findings on Efficacy and Safety of Prostatic Artery Embolization

Wednesday, April 2, 2025

10:39 AM – 10:48 AM CT

Location: Music City Center, 205 A

Presenting Author(s)

Matthew A. Carter (he/him/his)

Medical Student
David Geffen School of Medicine at UCLA, United States

Author/Co-author(s)

Antonio D. Moreno (he/him/his)

Medical Student
David Geffen School of Medicine at UCLA, United States
ZH

Zachary Haber, MD (he/him/his)

Assistant Professor
UCLA, United States
MQ

Matthew Quirk

United States
Adam Plotnik, MD, FSIR

Associate Clinical Professor
UCLA , United States
Justin McWilliams, MD, FSIR

Professor of Interventional Radiology
David Geffen School of Medicine at UCLA, United States

Purpose: Prostatic Artery Embolization (PAE) is a recognized treatment for lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH); however, its effectiveness in patients with concurrent bladder dysfunction is not well understood. This study aimed to evaluate the efficacy of PAE for patients with LUTS due to BPH in patients with abnormal bladder findings on pre-procedure imaging.

Materials and Methods: Between April 2012 and December 2023, all patients who underwent PAE for BPH with moderate to severe LUTS were included for analysis. Patients with indwelling foley catheters were excluded from analysis. Patients were evaluated for the presence of bladder diverticula, bladder stones, marked bladder distention ( > 10 cm from base to apex), and marked bladder wall thickening ( > 5 mm) pre-procedure using computed tomography (CT) or magnetic resonance imaging (MRI). Urologic outcome measures were evaluated at baseline and 3 months post-procedure.

Results:
A total of 309 procedures were included for analysis. The mean patient age was 71.2 years (42-94 years) with a baseline IPSS of 20.9 (± 7.0; range: 4-35) and QoL score of 4.6 (± 1.1; range: 1-6). Technically successful bilateral PAE occurred in 98% of cases. Two patients experienced major adverse events during follow-up with both developing groin pseudoaneurysms requiring thrombin injection.

Patients with evidence of bladder diverticula on pre-procedure imaging were found to have a significantly reduced response to PAE (p< 0.05), with an average IPSS improvement of 8.2 points (95% CI: [5.2, 11.3]) compared to 12.0 points (95% CI: [10.8, 13.3]) among patients without diverticula. There was no significant difference in QoL score improvement with bladder diverticula patients improving by 2.2 points (95% CI: [1.4, 3.0]) compared to 2.9 points (95% CI: [2.6, 3.1]) among patients without diverticula. No significant differences in IPSS or QOL improvement were identified among patients with findings of bladder stones, bladder wall thickening, or bladder distention versus those without those abnormal imaging findings.

Conclusion: Patients with pre-procedure imaging exhibiting bladder diverticula demonstrate a reduced clinical response to PAE.