SIR 2024
Embolization
Ajay Varadhan, BS
Northwestern Interventional Radiology Research Fellow and Medical Student
Northwestern University Feinberg School of Medicine, Chicago, IL
Financial relationships: Full list of relationships is listed on the CME information page.
Piyush Goyal, BS
Medical Student
Northwestern University Feinberg School of Medicine, Chicago, IL
Disclosure information not submitted.
Elias Hohlastos, MD
Professor
Northwestern University Feinberg School of Medicine
Disclosure information not submitted.
Kimberly Jenkins, n/a
Patient Care Coordinator
Northwestern Memorial Hospital
Disclosure information not submitted.
Riad Salem, MD, FSIR, MBA
Professor
Northwestern Memorial Hospital
Financial relationships: Full list of relationships is listed on the CME information page.
Samdeep Mouli, MD
Associate Professor
Northwestern University Feinberg School of Medicin
Financial relationships: Full list of relationships is listed on the CME information page.
Treatment options for recurrent lower urinary tract symptoms (LUTS) following minimally invasive surgical techniques (MIST) are limited and include more invasive surgical options such as transurethral resection of the prostate (TURP). LUTS recurrence after both TURP and MISTs have been reported with rates ranging from 10-50% depending on study and length of follow-up {1,2}. In treatment naïve patients, prostate artery embolization (PAE) demonstrated improvements in clinical symptoms, sexual function, and time to recurrence {3, 4}. This study aims to report safety and efficacy of PAE in patients with refractory LUTS after prior MIST.
Materials and Methods:
We retrospectively analyzed 16 patients who underwent PAE for LUTS after having undergone a prior MIST. Patients were followed at 1, 3, 6 and 12 months after PAE. Relevant clinical outcomes also included Available International Prostate Symptom (IPSS), Quality of Life (QoL), Benign Prostatic Hyperplasia Impact Index (BPH-II), and Male Sexual Health questionnaire (MSHQ-EjD). These were compared with paired t-tests with p≤0.05 as significant.
Results:
A total of 16 patients were evaluated for this study. The average age of patients in the study at the time of PAE was 68.9 ± 9.0 years. Prior MISTs in the study included: 6 UroLift, 5 Rezum, 3 GreenLight, 1 TUNA and 1 TUMT. Baseline prostate volume at time of PAE was 112.9 ± 52.7 mL. Average duration between prior MIST and PAE was 3.3 ± 2.2 years. Median duration to last follow-up questionnaire that was returned post-PAE was 8.1 ± 5.5 months. Successful bilateral PAE was achieved in all patients. The mean IPSS for the cohort before and after PAE was 23.5 ± 5.1 and 11.6 ± 7.2, respectively (p< 0.05). IPSS, QoL, and BPH-II scores were reduced from 23.5 ± 4.9, 4.9 ± 0.9, and 8.2 ± 3.2 respectively to 11.6 ± 7.2, 2.0 ± 1.6, and 3.1 ± 2.9 post-PAE (p< 0.05). Clinically successful reduction in IPSS, QoL, and BPH-II was achieved in 14/16 patients.
Conclusion:
14 patients achieved significant improvement in IPSS, QoL, and BPH-II scores, and there were no significant adverse events. Optimal management of surgically refractive LUTS depends on a balance between prostate gland size, treatment availability, symptom severity, and desire to maintain sexual function. This study demonstrates that PAE in patients who have previously undergone MISTs can be technically feasible, safe, and efficacious. Patients with refractory LUTS symptoms after MIST have limited options. This preliminary data demonstrates that PAE can be offered as a treatment option for patients with refractory LUTS after MIST and requires further study.