Prostate Artery Embolization for Lower Urinary Tract Symptoms Secondary to Benign Prostatic Hyperplasia: Results From a Prospective FDA-Approved Investigational Device Exemption Study - 17/09/18

Doi : 10.1016/j.urology.2018.07.012

Riad Salem ^a,^⁎ , John Hairston ^b, Elias Hohlastos ^a, Ahsun Riaz ^a, Joseph Kallini ^a, Ahmed Gabr ^a, Rehan Ali ^a, Kimberly Jenkins ^a, Jennifer Karp ^a, Kush Desai ^a, Bartley Thornburg ^a, David Casalino ^c, Frank Miller ^c, Matthias Hofer ^b, Nabeel Hamoui ^b, Samdeep Mouli ^a
^a Department of Radiology, Section of Interventional Radiology, Northwestern University, Chicago, IL
^b Department of Urology, Northwestern University, Chicago, IL
^c Department of Radiology, Section of Body Imaging, Northwestern University, Chicago, IL

^⁎Address correspondence to: Riad Salem, MD, MBA, Department of Radiology, Section of Interventional Radiology, Northwestern University, 676 N. St. Clair, Suite 800, Chicago, IL 60611.Department of RadiologySection of Interventional RadiologyNorthwestern University,676 N. St. Clair, Suite 800ChicagoIL60611.

Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Monday 17 September 2018

Abstract

Objective

To evaluate the safety and efficacy of prostate artery embolization (PAE) for lower urinary tract symptoms (LUTS) attributed to benign prostatic hyperplasia (BPH).

Methods

A prospective, single-center, open-label FDA-approved study was conducted to evaluate the safety and efficacy of PAE for LUTS secondary to BPH. We enrolled men ≥ 45, prostate volume > 40 g, International prostate symptom score (IPSS) > 13, peak flow rate (Q_max) ≤ 12 mL/s, and voided volume ≥ 125 mL. Patients were evaluated with questionnaires (IPSS, quality-of-life [QoL], International index of erectile function, and male sexual health questionnaire for ejaculatory dysfunction) and clinical measures (postvoid residual volume and Q_max at baseline 1, 3, and 12 months) after PAE. Baseline and 6-month total prostate (TV) and central gland (CG) volumes were obtained.

Results

45 patients (mean volume: 99 cc, range: 30-214 g) were treated over the course of the 3-year study. At 1 month, there were improvements in IPSS (23.6 ± 6.1 to 12.0 ± 5.9, P < .0001), QoL (4.8 ± 0.9 to 2.6 ± 1.6, P < .0001), Q_max (5.8 ± 1.0 to 12.4 ± 6.8,P < .0001). At 3 months, there were improvements in IPSS (10.2 ± 6.0, P < .0001), QoL (2.4 ± 1.6, P < .0001) and Q_max (15.3 ± 12.3, P < .0001). At 6 months, there were improvements in IPSS (11.0 ± 7.6, P < .0001) and QoL (2.3 ± 1.7, P < .0001). At 1 year, there were improvements in IPSS (12.4 ± 8.4,P < .0001) and QoL (2.6 ± 1.6, P < .0001). There were reductions in postvoid volume residues: baseline 157 ± 45, 1 month 123 ± 47, P = .057, 3 months 127 ± 114, P = .34, 6 months 112±116, P = .002 and 1 year 109±116 P = .025. Median decreases in TV and CG were 18% (CI: 13-27) (P = 0.0001) and 27% (CI: 20-36)(P = 0.0001), respectively. Self-limited adverse events included dysuria (n = 13), hematuria (n = 6), hematospermia (n = 2), urinary frequency (n = 3) and retention (n = 2). No severe adverse events, nontarget embolization, or adverse effects on erectile function or sexual health.

Conclusion

This prospective clinical trial demonstrates that PAE is safe and efficacious for BPH, with significant improvement in LUTS and reduction in TV and CG volumes.

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Plan

	Financial Disclosure: The authors declare that they have no relevant financial interests.
	Funding: This study was funded by Northwestern Medicine.