Prostatic artery embolization

Prostatic artery embolization (PAE, or prostate artery embolisation) is a new/experimental treatment for benign prostatic hypertrophy.[1]

The procedure involves blocking small prostatic arteries using microparticles injected via microcatheters,[2] obstructing blood supply to the prostate gland. It is a minimally invasive procedure which can be performed under local anaesthesia and as an outpatient procedure.[2]

Medical Uses

Prostatic artery embolization is primarily used as an alternative therapy to treat the symptoms of benign prostatic hypertrophy (BPH). BPH is an enlargement of the prostate gland that results in numerous symptoms, many of which are related to the urinary system. Some of the most common urinary symptoms are nocturia, weak stream, increased urinary frequency and sense of incomplete bladder emptying.[3]

Traditionally, benign prostatic hyperplasia is treated with either medical therapy or surgery. These treatments have side effects and potential risks which makes a minimally invasive procedure like embolization appealing. Sexual dysfunction and orthostatic hypotension are side effects of traditional pharmacotherapy.[4]  An initial study showed that PAE was successful in 95% of cases and led to improvements in quality of life and reduction of symptoms. Importantly, this study had no incidences of major or minor complications.[5]

A larger study of 1,000 patients confirmed that PAE is an effective alternative in treating BPH. It showed that treatment remained effective in 78% of men for three or more years.[6]

PAE may also prove beneficial in men with extreme prostate enlargement (100 cm^3) that have their treatment options limited by their prostate size. 76.2% of men with extreme enlargement that were treated with PAE retained symptom remission for greater than three years.[6]

Adverse Effects

As a relatively new procedure, more data is needed to determine potential adverse events related to prostatic artery embolization. One case series noted bladder wall ischemia as a complication,[7] while another case series noted ischemic rectitis as a complication.[8] The majority of adverse effects during PAE are likely due to non-target embolization, and are generally self-limited in nature. In addition, post-embolization syndrome, which consists of symptoms of pain, mild fever, malaise, nausea, vomiting and night sweats, is a commonly recorded postprocedural complication managed with NSAIDS and other forms of analgesia. One study found an overall complication rate of 20.6%, with minor complications including hematospermia, diarrhea, and urethral trauma from foley insertion, with one major complication of UTI requiring intravenous antibiotics.[9]

Procedure

After local anesthesia is placed, an interventional radiologist obtains access to the arterial system by piercing the femoral or radial artery, usually under ultrasound guidance, with a hollow needle known as a trocar. Through the needle a guidewire is threaded and subsequently the trocar is removed. A cannula is slid over the guidewire and once in place the guidewire is removed. This cannula allows a sheath to be inserted into the artery.8 Contrast dye is injected through the sheath under fluoroscopic imaging showing the arterial anatomy. This technique is used to help locate the prostatic artery and advance the catheter to the ostium of the prostatic artery. Polyvinyl alcohol particles are then injected into the prostatic artery. They function by causing embolization (blockage of the artery) preventing blood flow to the prostate, functionally resulting in reduced prostate size.[10]

See also

References

  1. ↑ "Prostate artery embolisation for benign prostatic hyperplasia | Guidance and guidelines | NICE". www.nice.org.uk. Retrieved 2017-03-08.
  2. 1 2 "Prostate artery embolisation for benign prostatic hyperplasia | 2-The-procedure | Guidance and guidelines | NICE". www.nice.org.uk. Retrieved 2017-03-08.
  3. ↑ Norman, RW; Nickel, JC; et al. (1994). ""Prostate-related symptoms" in Canadian men 50 years of age or older: prevalence and relationships among symptoms". Br J Urol. 74 (5): 542–550.
  4. ↑ Traish, AM; Hassani, J; Guay, AT; et al. (2011). "Adverse Side Effects of 5α‐Reductase Inhibitors Therapy: Persistent Diminished Libido and Erectile Dysfunction and Depression in a Subset of Patients.". J Sex Med. 8 (3): 872–884.
  5. ↑ Kaplan, SA (2015). "Re: Early results from a United States trial of prostatic artery embolization in the treatment of benign prostatic hyperplasia". J. Urol. 193 (4): 1316–1317.
  6. 1 2 Pisco, JM; Bilhim, T; Ribeiro, M; et al. (2017). "Short-, medium-, and long-term outcome of prostate artery embolization for patients with benign prostatic hyperplasia: 1000 patients". J Vasc Interv Radiol. 28 (2): S3.
  7. ↑ Babaei, MR (2014). "Prostatic Arterial Embolization to Treat Benign Prostatic Hyperplasia (PAE)". Iran J Radiol. 11(S1).
  8. ↑ Moreira, AM; Marques, CFS; Antunes, AA; et al. (2013). "Transient ischemic rectitis as a potential complication after prostatic artery embolization: case report and review of the literature". Cardiovasc Intervent Radiol. 36 (6): 1690–1694.
  9. ↑ Assis, AM; Rodrigues, VCP; Yoshinaga, EM; et al. (2015). "Prostatic artery embolization (PAE) for treatment of benign prostatic hyperplasia in patients with prostates exceeding 90g: a prospective single center study". J Vasc Interv Radiol. 26 (1): 87–93.
  10. ↑ Wang, MQ; Guo, LP; Zhang, GD; et al. (2015). "Prostatic arterial embolization for the treatment of lower urinary tract symptoms due to large (>80 mL) benign prostatic hyperplasia: results of midterm follow-up from Chinese population.". BMC Urol. 2015 (15): 33.
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