Evaluating Zones of Prostate Embolization with N-Butyl Cyanoacrylate and Changes in International Prostate Symptom Score (IPSS)

Wednesday, April 2, 2025

10:30 AM – 10:39 AM CT

Location: Music City Center, 205 A

Presenting Author(s)

Jade Lerner, MD (she/her/hers)

Resident
Icahn School of Medicine at Mount Sinai, United States

Author/Co-author(s)

Ramita N. Gowda, MPH

Medical Student
St. George's University School of Medicine, United States
David Bamshad, MD

Fellow PGY6
The Mount Sinai Hospital, United States
JV

Jenanan Vairavamurthy, MD

Assistant Professor of Radiology
Mount Sinai, United States
Dan Shilo, MD

Assistant Professor
Mount Sinai, United States
KG

Kirema Garcia-Reyes, MD

Assistant Professor
Mount Sinai, United States
Vivian Bishay, MD

Associate Professor
Icahn School of Medicine at Mount Sinai Hospital, United States
RP

Rajesh I. Patel, MD

Assistant Professor of Radiology and Surgery
Icahn School of Medicine at Mount Sinai, United States
Robert A. Lookstein, MD

Professor of Radiology and Surgery
Icahn School of Medicine at Mount Sinai, United States
AF

Aaron M. Fischman, MD

Professor of Radiology and Surgery
Mount Sinai Health System, United States
AR

Ardeshir Rastinehad, MD

Professor of Urology and Radiology Vice Chair at the Smith Institute for Urology at Lenox Hill
Northwell Heatlh, United States

Purpose:

Prostate artery embolization (PAE) has become an effective therapy for treating benign prostatic hyperplasia (BPH) and reducing lower urinary tract symptoms (LUTS). However, there is limited data evaluating the procedural characteristics with clinical outcomes. Using embolization zones, a classification system developed by Dr. Rastinehad, this study aims to analyze the effects of targeted prostatic embolization with n-butyl cyanoacrylate (n-BCA) and corresponding changes in the International Prostate Symptom Score (IPSS).

Materials and Methods:

A retrospective review of 103 patients who underwent n-BCA-PAE for BPH between June 2022 and April 2024 was conducted. The prostatic zone of embolization was categorized as Zone 1, Zone 2, and Zone 3 on review of procedural imaging. As established by Dr. Rastinehad, Zone 1 involves embolization of peripheral capsular arteries, Zone 2 includes embolization of transitional and/or central gland, and Zone 3 extends distally including the midline of the ipsilateral gland. Both laterality scores were summarized to assign an overall embolization grade: Grade 0-2, Grade 3-4, Grade 5-6. Changes in IPSS were correlated with the zones of embolization to assess the impact of targeted embolization on symptom relief.

Results:

The mean pre-procedure IPSS score was 21 and the mean post-procedure IPSS score measured at an average of 7 weeks was 10. Grade 0-2 (N=1) had a corresponding IPSS increase of 1. Grade 3-4 (N=12) had a corresponding average IPSS reduction of 8.3±8.6. Grade 5-6 (N=90) had a corresponding average IPSS reduction of 11.3±8.3.

Conclusion:

Prostate Artery Zone 3 embolization, targeting the distal prostatic arterioles, produced the greatest reduction in LUTS. These findings highlight the importance of utilizing a visual endpoint to assess zone-specific embolization results and can aid in predicting clinical success for patients post prostate artery embolization.