Prostatic Artery Embolization in Nonindex Benign Prostatic Hyperplasia Patients: Single-center Outcomes for Urinary Retention and Gross Prostatic Hematuria

Abstract

Objective: To present outcomes for prostatic artery embolization (PAE) to treat urinary retention and gross prostatic hematuria in nonindex benign prostatic hyperplasia patients.

Materials and methods: Seventy-five patients undergoing PAE from December 2013 to August 2018 (age = 77.5 ± 8.6, age-adjusted Charlson comorbidity index = 4.6 ± 2.0, prostate volume = 224 mL ± 135 mL) for retention (n = 46) and/or gross prostatic hematuria (n = 55) were retrospectively reviewed. Twenty-six patients had both problems. Urinary retention patients (UR, n = 46, catheterization = 162.4 ± 148.1 days) underwent voiding trials 1-2 months post-PAE, with International Prostate Symptom Score (IPSS), Quality of Life (QoL), and postvoid residual (PVR) recorded at 3, 6, 12, 24, and 36 months. Pre- and post-PAE hematuria-related visits were compared for gross hematuria patients (GH, n = 39), as were transfusion rates for severe hematuria patients requiring bladder irrigation (SH, n = 16). Ninety-day adverse event tabulation used Clavien-Dindo classification.

Results: Three months post-PAE, 33/38(87%) UR patients were catheter-free (IPSS = 8.9 ± 5.3, QoL = 1.6 ± 1.7, PVR = 158 mL ± 207 mL). Results were similar at 6 months (catheter-free = 26/28(93%), IPSS = 6.5 ± 4.4, QoL = 1.1 ± 0.9, PVR = 149 mL ± 139 mL), 12 months (catheter-free = 19/20(95%), IPSS = 4.7 ± 4.8, QoL = 0.6 ± 0.9, PVR = 125 mL ± 176 mL), 24 months (catheter-free = 11/12(92%), IPSS = 4.4 ± 3.0, QoL = 0.9 ± 0.8, PVR = 66 mL ± 68 mL), and 36 months (catheter-free = 5/6(83%), IPSS = 5.8 ± 3.8, QoL = 0.8 ± 1.0, PVR =99 mL ± 71 mL). Out of 37, 34(92%) GH patients remained hematuria-free at 483 ± 137 days, with 22 hematuria-related visits pre-PAE vs none post-PAE. Hematuria resolved <48 hours post-PAE in 14/16(87.5%) SH patients, with 36 blood units transfused pre-PAE, 4 units transfused <48 hours post-PAE, and none thereafter. Subsequently, 13/16(81%) remained hematuria-free at 500 ± 501 days; 2/16(13%) required fulguration; 1/16(6%) developed bladder tumor. There were 2 deaths <30 days post-PAE, and 8(11%) Grade-II urinary infections.

Conclusion: PAE provided safe, effective, and durable treatment for retention and gross hematuria in nonindex benign prostatic hyperplasia patients.