Patterns of Reperfusion and Clinical Findings in Repeat Prostate Artery Embolisation for Recurrent Lower Urinary Tract S
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CLINICAL INVESTIGATION
EMBOLISATION (ARTERIAL)
Patterns of Reperfusion and Clinical Findings in Repeat Prostate Artery Embolisation for Recurrent Lower Urinary Tract Symptoms in Patients with Benign Prostatic Hyperplasia Daniel J. Kearns1
•
Philip Boardman1 • Charles R. Tapping1
Received: 4 June 2020 / Accepted: 26 September 2020 Springer Science+Business Media, LLC, part of Springer Nature and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2020
Abstract Purpose To present our experience of the patterns of revascularisation of the prostate and efficacy of repeat prostate artery embolisation (rPAE) in patients with recurrence of lower urinary tract symptoms. Materials and Methods We retrospectively analysed 12 patients who underwent rPAE at a single centre between November 2015 and March 2020. The patients had their intraprocedural angiography and cone beam CT images as well as their pre-procedural CT retrospectively reviewed to establish the patterns of revascularisation. Clinical followup occurred at a minimum of 3 months. Results 11/12 patients (91.6%) had significant international prostate symptom score (IPSS) reduction following rPAE with change in mean IPSS from 18.4 to 8.1 at 3 months (p \ 0.0001). Mean prostate volume was reduced by 41.6% (p = 0.03). 8/12 (75%) had a complete clinical success. 20/24 hemiprostates demonstrated revascularisation angiographically, of which 16 (80%) had prostatic arterial supply at rPAE by the main prostatic artery. Other mechanisms of revascularisation included supply from capsular prostatic artery branches and supply from other internal iliac pelvic branches. Unilateral embolisation at rPAE, where bilateral embolisation was not feasible (4/12), resulted in no difference in clinical outcomes compared with bilateral rPAE (p = 0.55). Conclusion We have found rPAE to be an effective treatment for recurrent lower urinary tract symptoms in
& Daniel J. Kearns [email protected] 1
Department of Interventional Radiology, Churchill Hospital, Oxford University Hospitals Trust, Oxford, UK
patients who had good clinical response to initial PAE. The mechanisms of revascularisation are variable, but most patients that underwent rPAE had recanalisation of their main prostatic artery. Keywords Prostate Embolisation PAE rPAE
Introduction Prostate artery embolisation (PAE) is an established minimally invasive treatment of lower urinary tract symptoms (LUTS) in patients with benign prostatic hyperplasia (BPH). Its safety and efficacy have been explored through various prospective studies (including 6 randomised controlled trials) and meta-analyses [1–8], which led to its 2018 approval by the UK’s National Institute for Care and Health Excellence [9]. Recurrence of symptoms is a growing concern and repeat PAE (rPAE) is emerging as a treatment strategy, but data are limited [10]. The estimated rate of recurrence of LUTS after PAE is 5–28% [1, 11–13] with varying rates of re-intervention following this. Maclean et al. found, over a 3-year follow-
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