Purpose: To report and update our single center’s medium-term outcomes of Prostatic Artery Embolization.
Material and Methods: Prostatic artery embolization was performed on 270 patients from 2014 to 2019. Severity of lower urinary tract symptoms (LUTS) was measured before and after the procedure through international prostate symptom score (IPSS), quality of life (QOL), International Index of Erectile Function (IIEF) score, maximum urinary flow rate (Qmax) and post void residual (PVR) measurements, which were followed-up from 1 month up to 4 years. Prostate volume was followed up by pre/post-procedure MRI. Additional review of radiation dose was done.
Results: The mean patient age was 70.2 years (range 48-97). In patient with LUTS, the international prostate symptom score has reduced from 21.6 before procedure, to 9.9 at 6 months, and to 10.2, 11.7, 10, and 11.1 at 1, 2, 3, and 4 years respectively. The quality of life score has improved from 4.6 to 2, 1.9, 2.8, 2, and 1.8 at same time periods. The average pre-procedure prostatic volume was 128.8 ml which dropped to 99.5 ml at 2-6 months, and 100 ml at 7-19 months, but, unexpectedly, there was a rise in mean prostatic size to 146.6 ml at and above 20 months. The PAE procedure was successful in 261 patients (96.5% technical success). Nine failed procedures, 6 of them were caused by prostatic arteries occlusion/stenosis). PAE was done for BPH alone in 216 procedures and for BPH with urinary retention in 33 procedures. PAE was done for heamaturia of prostatic origin for 21 patients with technical success in 20 patients (95%). In catheterized patients, PAE helped catheter removal in 18 of 33 patients (54.5%). Mean fluoroscopy time of the procedure was 34.37 minutes, with a mean dose area product (DAP) of 9275 mGy∙m2 and mean skin dose of 834.1 mGy. Compared to cases done before June 2017 (157), we managed to reduce the mean fluoroscopy time in the following 113 patients by 11.3%, mean dose area product (DAP) by 24.2%, and mean skin dose by 20.66%.
Conclusions: Prostatic artery embolization is efficient in treating symptomatic BPH. Radiation exposure to the patient and operator could be reduced with increased operator experience and using minimal required fluoroscopy.