João Martins Pisco, professor and chair, Department of Radiology, Lisbon, Portugal, and one of the pioneers of the procedure, tells Interventional News about his personal experience with prostatic artery embolization.
What are the indications for prostatic artery embolization?
The indications for prostatic artery embolization are patients with benign prostatic hyperplasia and moderate-to-severe symptoms without response to medical treatment for at least six months, with prostate larger than 40cc, with IPSS (International Prostate Symptoms Score) equal or superior to 18 and quality of life equal or greater than three and prostate larger than 40cc. The exclusion criteria are malignancy, advanced atherosclerosis and bladder or stone diverticulae.
Many patients are asymptomatic and they do not need any treatment. The most frequent symptoms are: lower urinary tract symptoms (LUTS), such as higher urinary frequency particularly at night (nocturia), decreased, hesitant, interrupted urinary stream, urinary urgency and leaking.
What are the advantages of the procedure?
The advantages are that it is an outpatient procedure (patients go home four to eight hours after), morbidity is low, there is no sexual dysfunction, no bleeding, no urinary incontinence, no pain, no need for further medical treatment, no scar, no limitation for the procedure concerning prostate volume and local anaesthesia.
TURP can be performed only in patients with prostate smaller the 60–80cc, but embolization can be performed even if the prostate is larger than 200cc.
How many cases have you performed so far?
We have treated 232 patients.
What are the early results?
The initial results after the procedure are clinical improvement in about 85 to 90%. However, at one to 2.5 years there are about 10% of recurrences. Despite this some patients feel better than before the treatment. In order to obtain good results, it is important to critically select patients.
What are the possible complications with the procedure?
Most complications are related to catheter such as inguinal haematoma, bruise, arteriolar dissection and small artery rupture. Other complications also very rare and fewer than 10% are: urinary tract infection, haematuria, haemospermia, rectorrhagia, temporary urinary retention and balanoposthitis. We had only one major complication a case of bladder ischaemia that was treated by surgical removal without bladder reconstruction. To avoid urinary infection the patients should take an antibiotic before and after the procedure.
Where can interventional radiologists learn about the procedure?
The best way of learning the procedure is the observation in centres where the procedure is performed. The most important thing to bear in mind is the anatomy of the prostatic arteries and the arteries with anastomosis where embolization may lead to complications. For the purpose the patients should have a quality CT angiography before the procedure. With this information, some patients may be excluded. If they are selected to undergo the procedure, a careful approach should be taken concerning inguinal side to be punctured and catheters to be used.
What materials do you use?
The materials used are catheters, guidewire microcathers and the embolic agent. We have been using polyvinyl alcohol (100µm and 200µm).
João Martins Pisco will be speaking on the topic at GEST 2012 US.