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Title: Safety and Efficacy of Occlusion of Large Extra-Prostatic Anastomoses During Prostatic Artery Embolization for Symptomatic BPH

Abstract

IntroductionDuring PAE, preembolization angiography of the prostatic artery can show large extra-prostatic shunts, at high risk, if embolized, of rectal or penile necrosis. We report our experience with 11 consecutive patients who underwent protective embolization of large extra-prostatic shunts before successful PAE.Materials and MethodsWe treated 11 consecutive male patients (mean age 67 years), part of a series of 55 consecutive male patients referred for PAE to treat LUTS due to BPH, between December 2013 and January 2015. The procedure involved the exclusion of an extra-prostatic shunt originating from the PA, prior to complete bilateral PAE. We compared the safety and efficacy of the 11 shunt exclusions followed by embolization of the PA to the other 44 basic PAE. Clinical success was defined as a decrease of 25 % or eight points of IPSS, QoL <3 or a one-point decrease, and a Qmax improvement of 25 % or 2.5 mL/s.ResultsWe had a 100 % rate of occlusion of the anastomosis. Bilateral embolization of the PA was performed in all patients with no additional time of procedure (p = 0.18), but a significant increase of dose area product (p = 0.03). Distal (PErFecTED) embolization was possible in 64 %. There was no worsening of erectile dysfunction, no rectal or penile necrosis, no immediatemore » or late other clinical complications. Clinical success was 91 % (mean follow-up: 3.5 months), compared to 78 % for the entire PAE group.ConclusionPAE using the protection technique in case of large extra-prostatic shunts is as safe and effective as basic procedures and does not induce any additional time of procedure.« less

Authors:
; ;  [1];  [2];  [1];  [3]; ;  [1]
  1. Université Paris Descartes - Sorbonne - Paris – Cité, Faculté de Médecine (France)
  2. Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Clinical Research Unit (France)
  3. Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Interventional Radiology Department (France)
Publication Date:
OSTI Identifier:
22645447
Resource Type:
Journal Article
Resource Relation:
Journal Name: Cardiovascular and Interventional Radiology; Journal Volume: 39; Journal Issue: 9; Other Information: Copyright (c) 2016 Springer Science+Business Media New York and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE); http://www.springer-ny.com; Country of input: International Atomic Energy Agency (IAEA)
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; ARTERIES; BIOMEDICAL RADIOGRAPHY; BPH; BYPASSES; COMPARATIVE EVALUATIONS; HAZARDS; NECROSIS; PATIENTS; RECTUM; SAFETY; VASCULAR DISEASES

Citation Formats

Amouyal, Gregory, E-mail: gregamouyal@hotmail.com, Chague, Pierre, E-mail: pierre.chague@gmail.com, Pellerin, Olivier, E-mail: olivier.pellerin@aphp.fr, Pereira, Helena, E-mail: helena.pereira@aphp.fr, Giudice, Costantino Del, E-mail: costantino.delgiudice@aphp.fr, Dean, Carole, E-mail: carole.dean@aphp.fr, Thiounn, Nicolas, E-mail: nicolas.thiounn@aphp.fr, and Sapoval, Marc, E-mail: marc.sapoval2@aphp.fr. Safety and Efficacy of Occlusion of Large Extra-Prostatic Anastomoses During Prostatic Artery Embolization for Symptomatic BPH. United States: N. p., 2016. Web. doi:10.1007/S00270-016-1412-4.
Amouyal, Gregory, E-mail: gregamouyal@hotmail.com, Chague, Pierre, E-mail: pierre.chague@gmail.com, Pellerin, Olivier, E-mail: olivier.pellerin@aphp.fr, Pereira, Helena, E-mail: helena.pereira@aphp.fr, Giudice, Costantino Del, E-mail: costantino.delgiudice@aphp.fr, Dean, Carole, E-mail: carole.dean@aphp.fr, Thiounn, Nicolas, E-mail: nicolas.thiounn@aphp.fr, & Sapoval, Marc, E-mail: marc.sapoval2@aphp.fr. Safety and Efficacy of Occlusion of Large Extra-Prostatic Anastomoses During Prostatic Artery Embolization for Symptomatic BPH. United States. doi:10.1007/S00270-016-1412-4.
Amouyal, Gregory, E-mail: gregamouyal@hotmail.com, Chague, Pierre, E-mail: pierre.chague@gmail.com, Pellerin, Olivier, E-mail: olivier.pellerin@aphp.fr, Pereira, Helena, E-mail: helena.pereira@aphp.fr, Giudice, Costantino Del, E-mail: costantino.delgiudice@aphp.fr, Dean, Carole, E-mail: carole.dean@aphp.fr, Thiounn, Nicolas, E-mail: nicolas.thiounn@aphp.fr, and Sapoval, Marc, E-mail: marc.sapoval2@aphp.fr. 2016. "Safety and Efficacy of Occlusion of Large Extra-Prostatic Anastomoses During Prostatic Artery Embolization for Symptomatic BPH". United States. doi:10.1007/S00270-016-1412-4.
@article{osti_22645447,
title = {Safety and Efficacy of Occlusion of Large Extra-Prostatic Anastomoses During Prostatic Artery Embolization for Symptomatic BPH},
author = {Amouyal, Gregory, E-mail: gregamouyal@hotmail.com and Chague, Pierre, E-mail: pierre.chague@gmail.com and Pellerin, Olivier, E-mail: olivier.pellerin@aphp.fr and Pereira, Helena, E-mail: helena.pereira@aphp.fr and Giudice, Costantino Del, E-mail: costantino.delgiudice@aphp.fr and Dean, Carole, E-mail: carole.dean@aphp.fr and Thiounn, Nicolas, E-mail: nicolas.thiounn@aphp.fr and Sapoval, Marc, E-mail: marc.sapoval2@aphp.fr},
abstractNote = {IntroductionDuring PAE, preembolization angiography of the prostatic artery can show large extra-prostatic shunts, at high risk, if embolized, of rectal or penile necrosis. We report our experience with 11 consecutive patients who underwent protective embolization of large extra-prostatic shunts before successful PAE.Materials and MethodsWe treated 11 consecutive male patients (mean age 67 years), part of a series of 55 consecutive male patients referred for PAE to treat LUTS due to BPH, between December 2013 and January 2015. The procedure involved the exclusion of an extra-prostatic shunt originating from the PA, prior to complete bilateral PAE. We compared the safety and efficacy of the 11 shunt exclusions followed by embolization of the PA to the other 44 basic PAE. Clinical success was defined as a decrease of 25 % or eight points of IPSS, QoL <3 or a one-point decrease, and a Qmax improvement of 25 % or 2.5 mL/s.ResultsWe had a 100 % rate of occlusion of the anastomosis. Bilateral embolization of the PA was performed in all patients with no additional time of procedure (p = 0.18), but a significant increase of dose area product (p = 0.03). Distal (PErFecTED) embolization was possible in 64 %. There was no worsening of erectile dysfunction, no rectal or penile necrosis, no immediate or late other clinical complications. Clinical success was 91 % (mean follow-up: 3.5 months), compared to 78 % for the entire PAE group.ConclusionPAE using the protection technique in case of large extra-prostatic shunts is as safe and effective as basic procedures and does not induce any additional time of procedure.},
doi = {10.1007/S00270-016-1412-4},
journal = {Cardiovascular and Interventional Radiology},
number = 9,
volume = 39,
place = {United States},
year = 2016,
month = 9
}
  • Rationale of prostatic artery embolization (PAE) in the treatment of symptomatic benign prostatic hyperplasia is conventionally believed to include two parts: shrinkage of the enlarged prostate gland as a result of PAE-induced ischemic infarction and potential effects to relax the increased prostatic smooth muscle tone by reducing the number and density of α{sub 1}-adrenergic receptor in the prostate stroma. This review describes new insights into the likely mechanisms behind PAE, such as ischemia-induced apoptosis, apoptosis enhanced by blockage of androgens circulation to the embolized prostate, secondary denervation following PAE, and potential effect of nitric oxide pathway immediately after embolization. Studiesmore » on therapeutic mechanisms in PAE may shed light on potentially new treatment strategies and development of novel techniques.« less
  • Pathological features of benign prostatic hyperplasia (BPH) dictate various responses to prostatic artery embolization (PAE). Typically, BPH originates in the transition zone and periurethral region, where should be considered the primary target area in PAE procedures. Given that histological heterogeneity of components in hyperplasia nodules, epithelial or stromal, identifying the more responsive nodules to PAE will have clinical implications. Since some lower urinary tract symptoms (LUTS) in patients with BPH are usually related to bladder outlet obstruction-induced changes in bladder function rather than to outflow obstruction directly, proper selection of candidate patients prior to PAE is of great clinical importance.more » BPH is a typical chronic progressive condition, suggesting PAE could aim not only to relieve LUTS but also to delay or prevent the clinical progression. Awareness of the pathological background of BPH is essential for interventional radiologists to improve clinical outcomes and develop new treatment strategies in clinical practice of PAE.« less
  • PurposeTo summarize current evidence on outcomes and complications of prostatic artery embolization as a treatment for patients with lower urinary tract symptoms secondary to benign prostatic hyperplasia.Methods and MaterialsA database search of MEDLINE, Embase, Web of Science, and Cochrane Library was performed for published literature up to August 2015 concerning PAE in the treatment of BPH. Inclusion and exclusion criteria were applied by two independent reviewers, and disagreements were resolved by consensus. Peer-reviewed studies concerning PAE with BPH with a sample size >10 and at least one measured parameter were included.ResultsThe search yielded 193 articles, of which ten studies representingmore » 788 patients, with a mean age of 66.97 years, were included. Patients had LUTS ranging from moderate to severe. At 6 months following procedure, PV, PVR, Qmax, IPSS, and QoL were significantly improved (P < 0.05), while for PSA there was no significant change. At 12 and 24 months, PV, PSA, PVR, Qmax, IPSS, and QoL were significantly improved (P < 0.05). IIEF was unchanged at 6 and 12 months but was significantly reduced at 24 months.ConclusionThis suggests that PAE is effective in treating LUTS in the short and intermediate term.« less
  • No abstract prepared.
  • PurposeTo appraise the efficacy and safety of prophylactic uterine artery embolization in pregnancy termination with placenta previa.MethodsA cohort of 54 consecutive patients with placenta previa underwent prophylactic uterine artery embolization before vaginal delivery from February 2012 to March 2015. Vaginal delivery was attempted in all patients. Cesarean section or hysterectomy was introduced when vaginal delivery failed.ResultsVaginal delivery succeeded in 50 patients (93.6%) and failed in 4 patients (6.4%), thereupon converted to cesarean delivery. No patients resorted to hysterectomy. Six patients (11.1%) underwent blood transfusion. None of clinical characteristics, including maternal age, gestational age, history of abortion, history of cesarean delivery,more » and volume of vaginal bleeding, was significantly associated with complete placenta previa (P > 0.05). However, patients with complete placenta previa had a significantly lower successful rate of vaginal delivery than did patients without complete placenta previa (81 vs 100%, P = 0.038). The rate of complications was 3.7%. No major complications were observed.ConclusionUterine artery embolization is an effective and safe technique to assist pregnancy termination with placenta previa, which may lower the risk of cesarean section, hysterectomy, and blood transfusion.« less