1Raana Kanwal, 1Zahid Amin Khan, 1Maria Rauf
1Shifa International Hospital
The study aims to report our very early experience with prostate artery embolisation in patients with benign prostatic hypertrophy (BPH) in Shifa International Hospital setting.
Material(s) and Method(s):
This retrospective study was approved by the Institutional Ethical Review Board, and informed consent was obtained from all the patients. This single-center study was conducted on 7 patients with prostate volumes ranging from 39–100 g. Prostate volume, uroflowmetry and the International Prostate Symptom Score (IPSS) were used to assess clinical and functional outcomes. Five patients with lower urinary tract symptoms due to benign prostatic hyperplasia. Among seven of them, two patients had indwelling penile catheters due to BPH. Follow-up was obtained at 3 months. Bilateral prostatic arterial embolisation was performed in 5 cases and unilateral embolisation in 2 cases. One patient who presented with an indwelling catheter had persistent symptoms despite shrinkage of his prostate and was later found to have had a preexisting uretheral stricture not initially diagnosed. No major complications were seen in any patient. One patient had a resistant UTI which responded to a change of antibiotics following his urine C&S reports.
Patients with a mean age of 67.5 years underwent prostate artery embolization. It was successful in all the cases. Bilateral embolization was performed in 7 patients and unilateral approach in 2 patients. Clinical improvement was characterized by a mean prostate volume reduction of 53 % and marked improvement in their IPSS score. All preexisting medications were no longer in use.
The initial experience with prostate embolization has been very rewarding and it is a great alternative treatment for BPH. It is a very safe and effective procedure but requires advanced endovascular skills and appropriate patient selection. It is especially indicated in patients in whom the prostate volume is more than 80 cc to avoid open prostatectomy, in those in whom antiplatelets therapy cannot be stopped due to significant co-existing cardiac issues, those unfit for general anesthesia or in younger men who are sexually active.