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Semin intervent Radiol 2019; 36(02): 142-148
DOI: 10.1055/s-0039-1688431
How I Do It
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Prostate Artery Embolization

Samdeep Mouli
1   Department of Radiology, Section of Interventional Radiology, Northwestern University, Chicago, Illinois
,
Elias Hohlastos
1   Department of Radiology, Section of Interventional Radiology, Northwestern University, Chicago, Illinois
,
Riad Salem
1   Department of Radiology, Section of Interventional Radiology, Northwestern University, Chicago, Illinois
› Institutsangaben Funding This study was funded by Northwestern Medicine.
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Publikationsdatum:
22. Mai 2019 (online)

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Benign prostatic hyperplasia (BPH) involves the proliferation of the transition zone of the prostate,[1] [2] with resultant bladder outlet obstruction (BOO) and lower urinary tract symptoms (LUTS; frequency, urgency, weak stream, nocturia). The prevalence increases with age, affecting 50% of men in their 50s, with symptoms degrading quality of life (QoL).[1] [2] Prostatic arterial embolization (PAE) is safe and effective, demonstrating high rates of technical success, improved urinary flow rates, and QoL.[3] [4]

PAE can be a technically challenging and time-consuming procedure, especially given the general age of this patient population and concomitant medical comorbidities. Early enthusiasm in the procedure was tempered by variable clinical and technical success rates.[5] [6] [7] [8] [9] These initial shortcomings were subsequently overcome by more standardization of techniques,[10] [11] and better understanding of patient selection and arterial anatomy.[3] [7] [12] [13] [14]

Utilizing this refined anatomical and procedural expertise, the goal of this article is to provide a standardized approach to PAE to overcome technical challenges described in the literature.

 

  • References

  • 1 McVary KT, Roehrborn CG, Avins AL. , et al. Update on AUA guideline on the management of benign prostatic hyperplasia. J Urol 2011; 185 (05) 1793-1803 . doi: 10.1016/j.juro.2011.01.074
    CrossrefPubMedGoogle Scholar
  • 2 Roehrborn CG. Pathology of benign prostatic hyperplasia. Int J Impot Res 2008; 20 (Suppl. 03) S11-S18
    PubMedGoogle Scholar
  • 3 Pisco JM, Bilhim T, Pinheiro LC. , et al. Medium- and long-term outcome of prostate artery embolization for patients with benign prostatic hyperplasia: results in 630 patients. J Vasc Interv Radiol 2016; 27 (08) 1115-1122
    CrossrefPubMedGoogle Scholar
  • 4 Kurbatov D, Russo GI, Lepetukhin A. , et al. Prostatic artery embolization for prostate volume greater than 80 cm3: results from a single-center prospective study. Urology 2014; 84 (02) 400-404
    CrossrefPubMedGoogle Scholar
  • 5 Kaplan SA. Prostate arterial embolization is a viable option for treating symptoms of benign prostatic hyperplasia: con. J Urol 2017; 198 (01) 9-11
    PubMedGoogle Scholar
  • 6 Carnevale FC, da Motta-Leal-Filho JM, Antunes AA. , et al. Quality of life and clinical symptom improvement support prostatic artery embolization for patients with acute urinary retention caused by benign prostatic hyperplasia. J Vasc Interv Radiol 2013; 24 (04) 535-542
    CrossrefPubMedGoogle Scholar
  • 7 Pisco J, Campos Pinheiro L, Bilhim T. , et al. Prostatic arterial embolization for benign prostatic hyperplasia: short- and intermediate-term results. Radiology 2013; 266 (02) 668-677
    CrossrefPubMedGoogle Scholar
  • 8 Bagla S, Martin CP, van Breda A. , et al. Early results from a United States trial of prostatic artery embolization in the treatment of benign prostatic hyperplasia. J Vasc Interv Radiol 2014; 25 (01) 47-52
    CrossrefPubMedGoogle Scholar
  • 9 Gao YA, Huang Y, Zhang R. , et al. Benign prostatic hyperplasia: prostatic arterial embolization versus transurethral resection of the prostate--a prospective, randomized, and controlled clinical trial. Radiology 2014; 270 (03) 920-928
    CrossrefPubMedGoogle Scholar
  • 10 Gonçalves OM, Carnevale FC, Moreira AM, Antunes AA, Rodrigues VC, Srougi M. Comparative study using 100-300 versus 300-500 μm microspheres for symptomatic patients due to enlarged-BPH prostates. Cardiovasc Intervent Radiol 2016; 39 (10) 1372-1378
    CrossrefPubMedGoogle Scholar
  • 11 Hwang JH, Park SW, Chang IS. , et al. Comparison of nonspherical polyvinyl alcohol particles and microspheres for prostatic arterial embolization in patients with benign prostatic hyperplasia. BioMed Res Int 2017; 2017: 8732351
    PubMedGoogle Scholar
  • 12 Bilhim T, Tinto HR, Fernandes L, Martins Pisco J. Radiological anatomy of prostatic arteries. Tech Vasc Interv Radiol 2012; 15 (04) 276-285
    CrossrefPubMedGoogle Scholar
  • 13 Bhatia S, Sinha VK, Abdul-Rahim O, Harward S, Narayanan G. Rare prostatic artery origins and the importance of collateral circulation in prostate artery embolization: a pictorial essay. Can Assoc Radiol J 2018; 69 (02) 220-229
    CrossrefPubMedGoogle Scholar
  • 14 Amouyal G, Pellerin O, Del Giudice C, Dean C, Thiounn N, Sapoval M. Variants of patterns of intra- and extra-prostatic arterial distribution of the prostatic artery applied to prostatic artery embolization: proposal of a classification. Cardiovasc Intervent Radiol 2018; 41 (11) 1664-1673
    CrossrefPubMedGoogle Scholar
  • 15 Salem R, Hairston J, Hohlastos E. , et al. Prostate artery embolization for lower urinary tract symptoms secondary to benign prostatic hyperplasia: results from a prospective FDA-approved investigational device exemption study. Urology 2018; 120: 205-210
    CrossrefPubMedGoogle Scholar
  • 16 Isaacson AJ, Raynor MC, Yu H, Burke CT. Prostatic artery embolization using Embosphere Microspheres for prostates measuring 80-150 cm(3): early results from a US trial. J Vasc Interv Radiol 2016; 27 (05) 709-714
    CrossrefPubMedGoogle Scholar
  • 17 Gomez C, Bhatia S, Carnevale FC, Narayanan G. Role of urodynamic studies in management of benign prostatic obstruction: a guide for interventional radiologists. J Vasc Interv Radiol 2017; 28 (01) 126-133
    CrossrefPubMedGoogle Scholar
  • 18 Wang MQ, Duan F, Yuan K, Zhang GD, Yan J, Wang Y. Benign prostatic hyperplasia: cone-beam CT in conjunction with DSA for identifying prostatic arterial anatomy. Radiology 2017; 282 (01) 271-280
    CrossrefPubMedGoogle Scholar
  • 19 de Assis AM, Moreira AM, de Paula Rodrigues VC. , et al. Pelvic arterial anatomy relevant to prostatic artery embolisation and proposal for angiographic classification. Cardiovasc Intervent Radiol 2015; 38 (04) 855-861
    CrossrefPubMedGoogle Scholar
  • 20 Bhatia S, Sinha V, Bordegaray M, Kably I, Harward S, Narayanan G. Role of coil embolization during prostatic artery embolization: incidence, indications, and safety profile☆ . J Vasc Interv Radiol 2017; 28 (05) 656-664.e3
    CrossrefPubMedGoogle Scholar
  • 21 Isaacson AJ, Bhalakia N, Burke CT. Coil embolization to redirect embolic flow during prostatic artery embolization. J Vasc Interv Radiol 2015; 26 (05) 768-770
    CrossrefPubMedGoogle Scholar
  • 22 Moreira AM, de Assis AM, Carnevale FC, Antunes AA, Srougi M, Cerri GG. A review of adverse events related to prostatic artery embolization for treatment of bladder outlet obstruction due to BPH. Cardiovasc Intervent Radiol 2017; 40 (10) 1490-1500
    CrossrefPubMedGoogle Scholar
  • 23 Desai H, Yu H, Ohana E, Gunnell ET, Kim J, Isaacson A. Comparative analysis of cone-beam CT angiogram and conventional CT angiogram for prostatic artery identification prior to embolization. J Vasc Interv Radiol 2018; 29 (02) 229-232
    CrossrefPubMedGoogle Scholar
  • 24 Bagla S, Sterling KM. Pitfalls of cone beam computed tomography in prostate artery embolization. Cardiovasc Intervent Radiol 2014; 37 (06) 1430-1435
    CrossrefPubMedGoogle Scholar
  • 25 Mohan PP, Sandhu J, Kably I. Retrograde prostatic arterial embolization via penile collateral in chronic total occlusion of the prostatic artery. J Vasc Interv Radiol 2018; 29 (09) 1331-1333
    CrossrefPubMedGoogle Scholar
  • 26 Haga N, Akaihata H, Hata J. , et al. The association between local atherosclerosis of the prostatic artery and benign prostatic enlargement in humans: Putative mechanism of chronic ischemia for prostatic enlargement. Prostate 2018; 78 (13) 1001-1012
    CrossrefPubMedGoogle Scholar
  • 27 Cimadamore A, Scarpelli M, Santoni M. , et al. Re: Friederike Haidl, David Pfister, Axel Heidenreich. Re: Prostatic artery embolization in the treatment of localized prostate cancer: a bicentric prospective proof-of-concept study of 12 patients. Mordasini L, Hechelhammer L, Diener PA, et al. J Vasc Interv Radiol 2018;29:589-97. Eur Urol 2018;74:525-6: Could morphologic changes in periprostatic arteries have an influence on prostatic artery embolization?. Eur Urol 2019; 75 (04) e110-e113
    CrossrefPubMedGoogle Scholar
  • 28 du Pisanie J, Abumoussa A, Donovan K, Stewart J, Bagla S, Isaacson A. Predictors of prostatic artery embolization technical outcomes: patient and procedural factors. J Vasc Interv Radiol 2019; 30 (02) 233-240
    CrossrefPubMedGoogle Scholar
  • 29 Isaacson AJ, Piechowiak RL, Nutting C, Bagla S. How to “get out of trouble” during prostatic artery embolization. Tech Vasc Interv Radiol 2018; 21 (04) 288-294
    CrossrefPubMedGoogle Scholar
  • 30 Amouyal G, Chague P, Pellerin O. , et al. Safety and efficacy of occlusion of large extra-prostatic anastomoses during prostatic artery embolization for symptomatic BPH. Cardiovasc Intervent Radiol 2016; 39 (09) 1245-1255
    CrossrefPubMedGoogle Scholar
  • 31 Zhang G, Wang M, Duan F. , et al. Radiological findings of prostatic arterial anatomy for prostatic arterial embolization: preliminary study in 55 Chinese patients with benign prostatic hyperplasia. PLoS One 2015; 10 (07) e0132678
    CrossrefPubMedGoogle Scholar
  • 32 Carnevale FC, Antunes AA. Prostatic artery embolization for enlarged prostates due to benign prostatic hyperplasia. How I do it. Cardiovasc Intervent Radiol 2013; 36 (06) 1452-1463
    CrossrefPubMedGoogle Scholar
  • 33 Bilhim T, Pisco JM, Rio Tinto H. , et al. Prostatic arterial supply: anatomic and imaging findings relevant for selective arterial embolization. J Vasc Interv Radiol 2012; 23 (11) 1403-1415
    CrossrefPubMedGoogle Scholar
  • 34 Bhatia S, Sinha VK, Kava BR. , et al. Efficacy of prostatic artery embolization for catheter-dependent patients with large prostate sizes and high comorbidity scores. J Vasc Interv Radiol 2018; 29 (01) 78-84.e1
    CrossrefPubMedGoogle Scholar
  • 35 Ali R, Gabr A, Mouli SK. , et al. MR imaging findings of the prostate gland following prostate artery embolization: results from a prospective phase 2 study. Abdom Radiol (NY) 2019; 44 (02) 713-722
    CrossrefPubMedGoogle Scholar
  • 36 Frenk NE, Baroni RH, Carnevale FC. , et al. MRI findings after prostatic artery embolization for treatment of benign hyperplasia. AJR Am J Roentgenol 2014; 203 (04) 813-821
    CrossrefPubMedGoogle Scholar
  • 37 Zhang H, Shen Y, Pan J. , et al. MRI features after prostatic artery embolization for the treatment of medium- and large-volume benign hyperplasia. Radiol Med (Torino) 2018; 123 (10) 727-734
    CrossrefPubMedGoogle Scholar