Tuesday, April 22, 2014

Embolization Shows Success in Benign Prostatic Hyperplasia Laird Harrison March 28, 2012


March 28, 2012 (San Francisco, California) — Prostatic artery embolization relieved the symptoms of benign prostatic hyperplasia in 2 studies presented here at the Society of Interventional Radiology 37th Annual Scientific Meeting.
The novel procedure, which has been tried in only 2 centers in the world, offers an alternative to transurethral resection of the prostate (TURP), with potentially fewer adverse reactions.
"This could mean that more men have a chance at getting their lives back," said researcher Francisco Cesar Carnevale, MD, PhD, professor and chief of the interventional radiology section at University of São Paulo in Brazil, in a statement.
"We're very happy," Dr. Carnevale told Medscape Medical News. "It's a feasible, effective, safe procedure."
In prostatic artery embolization, surgeons use microcatheters to place resin beads in the arteries that supply the prostate. The constricted blood flow causes the prostate to shrink, relieving pressure on the urethra. The procedure is done on an outpatient basis under local anesthesia.
A similar procedure has been used to treat uterine fibroids.
In one study, researchers from the University of São Paulo measured symptoms and objective changes in 11 men, 59 to 78 years of age (average, 68.5 years), with acute urinary retention due to an enlarged prostate. Follow-up ranged from 16 to 45 months.
At the time of treatment, the prostates ranged from 30 to 90 g (the normal male prostate weighs 20 to 25 g).
Magnetic resonance imaging (MRI) and ultrasound were used to study the exact anatomy of the prostate. The researchers analyzed 22 pelvic halves and saw a 30% reduction in mean prostate volume at 6 months.
All patients reported a high degree of satisfaction and an increased quality of life. Clinical success was achieved in 91% (10 of 11 patients).
"What makes this a difficult procedure is that there is varied anatomy," Michael Hamblin, MD, clinical assistant professor of radiology at the University of Illinois in Chicago, told Medscape Medical News. "You want to target specific branches and minimize potential complications. The most feared complication is impotence with any procedure done on the prostate."
About 5% of TURP patients suffer sexual dysfunction from the procedure, said Dr. Hamblin, who was not involved in the study.
Although none of the patients experienced complications during the procedure, the researchers warn that there is a risk for complications because the arteries involved have "varying origins, reduced diameters, tortuosity, and many anastomoses with other neighboring organs."
In a separate study, researchers from Saint Louis Hospital and the Faculdade de Ciências Médicas, both in Lisbon, Portugal, reported the results of embolization in 152 patients 47 to 85 years of age who had failed medical therapy. Of these, 18 had urinary retention and required indwelling catheters, and 8 had undergone previous partial prostatectomy.
The researchers reported technical success in 144 of 152 patients (94.7%), meaning that at least 1 prostatic artery was embolized.
The researchers reported clinical success at 3 months in 86 of 102 patients (84.3%), at 6 months in 60 of 74 patients (81.1%), at 12 months in 38 of 46 patients (82.6%), at 18 months in 13 of 16 patients (81.3%), and between 24 and 30 months in 7 of 10 patients (70%).
They documented 1 major complication: a 1.5 cm2 area of ischemia on the bladder wall that was surgically removal.
Minor complications included sensations of burning in the urethra, urinary infection, hematuria, hemospermia, balanoposthitis, rectorragies, inguinal hematoma and pain.
Dr. Hamblin and Dr. Carnavale have disclosed no relevant financial relationships.

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