13th Annual Global Embolization Symposium & Technologies
Purpose : To describe technical and clinical success after prostatic artery embolization (PAE) performed via a single unilateral prostatic artery that perfuses both halves of the gland.
Material and Methods : 140 patients underwent PAE with 100-300μm Embospheres at a single institution from April 2014 through August 2018. 1 patient had both prostatic arteries occluded. 4 (3%) had one prostatic artery occluded with only the contralateral half of the gland embolized from the opposite side. 8 (6%) had unilateral prostatic artery occlusion with both halves of the gland perfused by the contralateral artery (Figure 1) and were selected for study. Of these subjects (mean age=78.6±9.0, mean Charlson comorbidity index=4.5±2.0, mean gland volume=172±81mL) 4 underwent PAE for lower urinary tract symptoms (LUTS), 3 for retention, and 1 for severe hematuria. LUTS patients had baseline International Prostate Symptom Score (IPSS)=18.3±4.3, Quality of Life score (QOL)=4.3±1.3, and post-void residual (PVR)=142±232mL. Retention patients had mean time of retention=147 days. Subjects were evaluated at 1, 3, 6, 12 and 24 months after PAE. Adverse events up to 90 days were recorded.
Results : Embospheres penetrated both halves of the gland in all cases. After PAE, LUTS patients achieved mean IPSS=4.1±1.9 (down 77%), mean QOL=1.0±0.8 (down 73%), and mean PVR=78±56mL, with mean follow-up=362±290 days. 2 retention patients passed voiding trials within 1 month, remaining catheter-free at 7 and 24 months follow-up with IPSS/QOL of 12/- and 1/0 respectively. The hematuria patient had irrigation stopped, catheter removed, and near cessation of hematuria within 2 days after PAE despite being on anticoagulation. He and the third retention patient were lost to follow-up. There were no adverse events.
Conclusions : This cohort experienced improvement in LUTS, retention, and hematuria comparable to other larger series. When prostatic artery patency is unilateral, clinical improvement similar to that of bilateral PAE can be achieved if the patent contralateral artery perfuses both halves of the gland.