Preliminary results of prostate artery embolization as final treatment in selected BPH patients

Transcription

1 Preliminary results of prostate artery embolization as final treatment in selected BPH patients Poster No.: C-0888 Congress: ECR 2016 Type: Authors: Keywords: DOI: Scientific Exhibit F. Imani 1, D. Vroegindeweij 2, R. Wassenaar 3 ; 1 Rotterdam, Zuid- Holland/NL, 2 Sommelsdijk/NL, 3 DEN HAAG/NL Interventional vascular, Genital / Reproductive system male, Pelvis, Catheter arteriography, CT-Angiography, MR, Embolisation, Arthrography, Hyperplasia / Hypertrophy, Ischemia / Infarction /ecr2016/C-0888 Any information contained in this pdf file is automatically generated from digital material submitted to EPOS by third parties in the form of scientific presentations. References to any names, marks, products, or services of third parties or hypertext links to thirdparty sites or information are provided solely as a convenience to you and do not in any way constitute or imply ECR's endorsement, sponsorship or recommendation of the third party, information, product or service. ECR is not responsible for the content of these pages and does not make any representations regarding the content or accuracy of material in this file. As per copyright regulations, any unauthorised use of the material or parts thereof as well as commercial reproduction or multiple distribution by any traditional or electronically based reproduction/publication method ist strictly prohibited. You agree to defend, indemnify, and hold ECR harmless from and against any and all claims, damages, costs, and expenses, including attorneys' fees, arising from or related to your use of these pages. Please note: Links to movies, ppt slideshows and any other multimedia files are not available in the pdf version of presentations. Page 1 of 5

2 Aims and objectives Benign prostatic hyperplasia (BPH) is a common entity in elderly men. BPH is often associated with lower urinary tract symptoms (LUTS) (1). Medicinal therapy and Transurethral resection of the prostate (TURP) are the golden standard therapy (2). If not succesfull prostatectomy is the only remaining therapy. However this comes with significant complication rates (3). Whenever patients are not eligible for these treatments they have to live with a permanent urine catheter. Recently prostatic artery embolization (PAE) was introduced as an effective and minimal invasive treatment option. The aim of our study was to evaluate the efficacy of PAE in patients with a permanent urine catheter. Methods and materials From May 2014 till March 2015 a prospective study was performed to evaluate PAE in our clinic. Only patients with therapyresistent BPH who due to clinical conditions were not eligible for TURP were included. All included patients followed the same protocol. Pre-procedure CT-angiography was performed to analyse the vascular anatomy. Pre-procedure MRI-prostate was performed to detect underlying malignancy and to evaluate the prostate volume. Each PAE was performed by two interventional radiologists. Peri procedural Analgetics and Antibiotics were given. First attempt to remove the catheter was planned 3 weeks post procedure. Follow-up consisted of Post-intervention MRI, to determine prostate volume changes, and clinical data, e.g. urine catheter removal. Results 5 patients (mean age 79, range 77-81), all with permanent urine catheter, were included in the study and underwent PAE. All patients suffered from BPH with high prostate volumes (mean volume 109 ml, range ml). Table 1 on page 3 Page 2 of 5

3 All patients underwent PAE, performed by two interventional radiologists. PAE was technically succesfull (bilateral emoblization) in 3 patients (60%). 2 patients (40%) underwent unilateral/right sided embolization due to atherosclerosis and lack of stable position of the microcatheter. No direct complications were registered. Table 2 on page 3 Removal of the urine catheter was succesful in 3 patients (mean 41 days, range days). Pre-emoblization prostate volume of these patients was 62 ml (range ml). Follow-up MRI at 3 months showed a mean prostate volume reduction of 33.6% in the patients with succesfull urine catheter removal. Table 3 on page 4 Patients who underwent unilateral embolization, who had the largest prostates (mean 180 ml, range ml), did not have a succesfull urine catheter removal and showed no volume reduction on the follow-up MRI. Table 3 on page 4 Images for this section: Table 1: Base-line patient characteristics Radiology, Maasstad Ziekenhuis Rotterdam, Maasstad Ziekenhuis Rotterdam - Table 2: Table 2. Results Page 3 of 5

4 Radiology, Maasstad Ziekenhuis Rotterdam, Maasstad Ziekenhuis Rotterdam - Table 3: Table 3. Results Radiology, Maasstad Ziekenhuis Rotterdam, Maasstad Ziekenhuis Rotterdam - Page 4 of 5

5 Conclusion PAE is a relative safe treatment option It should be considered as a final treatment option in selected BPH patients not eligible for surgical treatment. Bilateral PAE seems to be necessary to create a succesful outcome. Succesful emoblization depends on the vascular anatomy, atherosclerosis and prostate volume. Also a relative small volume reduction of the prostate can give a succesful clinical outcome. Personal information F. Imani, Department of Radiology, Maasstad Hosptial, Rotterdam, The farshadimani@gmail.com T : References 1. Rosen R, Giuliano F. Carson C, et. al. Sexual dysfunction and lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH). Eur Urol 2005; 47: de Assis A, Moreira A, de Paula Rodrigues V, et. al. Prostatic embolization for treatment of Benign Prostatic Hyperplasia in patients with prostates >90 g: A Prospective Single-Center study. J Vasc Interv Radiol 2015; 26: Pisco M, Pinheiro L, Bilhim T, et. al. Prostatic Arterial Emoblization to treat Benign Prostatic Hyperplasia. J Vasc Interv Radiol 2011; 22: Page 5 of 5