- Email: [email protected]
Prostatic arterial embolization for refractory and recurrent hematuria: a single-center experience
S116
’
Tuesday
Scientific Session
for overnight observation. Patients were subsequently evaluated at 1 week, 3, 6 and 12 months after treatment, with repeat cystoscopy, anoscopy, and questionnaire evaluation at those intervals. Results: A total of 64 patients underwent initial screening. Eighteen patients met study criteria and underwent treatment. Embolization was not performed in 1 patient (6%) due to difficulty cannulating the prostate arteries. Two other patients (11%) underwent unilateral embolization due to nonvisualization of the left prostate artery. The remaining 15 patients (83%) were successfully embolized bilaterally. There were no immediate technical complications related to the procedure. Three patients had urinary symptoms, including dysuria and increased urinary frequency during their overnight admission, all of which were self-limiting. At 1 week follow up, 6 (42%) and 16 patients (83%) underwent a follow up anoscopy and cystoscopy, respectively, without evidence of procedure related rectal or bladder injury in any patient. The mean IPSS scores at baseline, 1week and 3 months were 23.3 (12-31), 14.5 (3-29), and 7.2 (2-21). The mean QoL scores at the same time points were 4.8 (3-6), 3.9 (2-6) and 1.2 (1-5). Conclusions: We found PAE to be safe without evidence of bladder or rectal injury. Initial symptomatic outcomes were promising with improvements in IPSS and QoL scores. Further prospective studies are needed to validate our findings.
TUESDAY: Scientific Sessions
3:27 PM
Abstract No. 266
Prostatic arterial embolization for refractory and recurrent hematuria: a single-center experience I. Kably1, S. Bhatia2, G. Narayanan1, S. Narayanan3; 1 University of Miami, Miami, FL; 2University of Miami, Davie, FL; 31987, Coral Gables, FL Purpose: Refractory hematuria due to bladder or prostate disease is a potentially life threatening condition and can present a major therapeutic challenge. The purpose of this study was to evaluate the efficacy of PAE for refractory or recurrent hematuria from the lower urinary tract (LUT). Materials: We retrospective reviewed the charts of 23 patients (mean age of 70.5 years) referred, between December 2013 and September 2016, for refractory or recurrent hematuria nonresponsive to conservative therapy. 24 embolization procedures were performed on 23 patients. The primary endpoint was duration until cessation of hematuria following PAE. Secondary endpoints included hemoglobin and prostate specific antigen level; prostate size before and after the procedure; blood transfusion requirements, follow-up duration and complications. Results: The immediate clinical success rate was 100%. Bilateral PAE was performed in 18 cases, PAE with bladder artery embolization (BAE) in 3 cases, and unilateral PAE in 3 cases. Cessation of hematuria was initially noted in all patients within an average of 1.4 days (range 1–7 days). The mean post-embolization follow-up was 182 days (range 45 days–15 months). At a mean follow-up of 6 months (range 30 days–15 months) four patients with cancer had recurrent hematuria, requiring a repeat procedure in one patient. Hemoglobin level significantly improved (p ¼ 0.0005) during the first week.
’
JVIR
Significant decreases were observed in post-procedural blood transfusion requirement (p ¼ 0.002) prostate size (p ¼ 0.006), and PSA level (p ¼ 0.17). 5 patients in retention were catheter free after an average interval of 48 days (range 1 to 180 days). Two patient presented with perineal pain and were managed conservatively. During follow-up, 3 patients died of underlying disease without recurrent bleeding. Conclusions: PAE is an efficacious therapy for hematuria originating from the LUT, with the best safety profile in the published literature.
3:36 PM
Abstract No. 267
Clinical outcomes and quality of life measures in the use of prostate artery embolization for prostates 480 g: a single-center experience
S. Bhatia1, V. Sinha2, C. Gomez3, S. Harward4, G. Narayanan1; 1University of Miami, Department of Interventional Radiology, Miami, FL; 2University of Miami, Miller School of Medicine, Miami, FL; 3University of Miami, Department of Urology, Miami, FL; 4The Dartmouth Institute for Health Policy and Clinical Practice, Arlington, MA Purpose: Surgical options for management of large prostate adenomas (480 g) are limited and entail significant morbidity. 1 We evaluate the efficacy and quality of life (QOL) impact of prostate artery embolization (PAE) for the treatment of benign prostatic hyperplasia (BPH) for prostates 480 g. Materials: Patient demographics, International Prostate Symptom Score (IPSS), QOL, prostate volume assessed by MRI, and post-void residual (PVR) volume were evaluated as part of an IRB-approved retrospective analysis at a single institution. Exclusion criteria included patients with active urinary tract infection, renal failure, or severe atherosclerosis. Patients with a history of recurrent infection and urinary retention were excluded from the analysis. Results: 43 patients underwent PAE for BPH with prostate size 480 g. Mean patient age was 67.4 years, mean baseline IPSS was 25.2, and mean prostate volume was 133.9 g. Mean (range) baseline QOL was 4.7 (2-6). At 1 month, 3 months, and 6 months, QOL score improved to 1.3 (po0.005), 0.83 (po0.005), and 0.92 (po0.005), respectively; IPSS decreased to 7.3 (po0.005), 5.9 (po0.005), and 5.7 (po0.005), respectively. At 3 months of follow up, mean prostate volume had decreased to 88.5 g (po0.005). PVR values at baseline and 3 months were 211.6mL and 46.6mL (po0.005) respectively. Three major complications were noted: two patients had urinary retention post PAE requiring indwelling catheter for 7 days and one patient was admitted for IV antibiotics to manage urosepsis. Conclusions: PAE achieved a clinically and statistically significant reduction in prostate size, IPSS score and PVR volume, and an improvement in QOL in patients with prostates 4 80 g. These findings suggest that PAE can be a valuable treatment option for BPH among men with 480 gram prostates with a favorable safety profile, when the conventional surgical options are limited and carry significant morbidity.
’
Tuesday
Scientific Session
for overnight observation. Patients were subsequently evaluated at 1 week, 3, 6 and 12 months after treatment, with repeat cystoscopy, anoscopy, and questionnaire evaluation at those intervals. Results: A total of 64 patients underwent initial screening. Eighteen patients met study criteria and underwent treatment. Embolization was not performed in 1 patient (6%) due to difficulty cannulating the prostate arteries. Two other patients (11%) underwent unilateral embolization due to nonvisualization of the left prostate artery. The remaining 15 patients (83%) were successfully embolized bilaterally. There were no immediate technical complications related to the procedure. Three patients had urinary symptoms, including dysuria and increased urinary frequency during their overnight admission, all of which were self-limiting. At 1 week follow up, 6 (42%) and 16 patients (83%) underwent a follow up anoscopy and cystoscopy, respectively, without evidence of procedure related rectal or bladder injury in any patient. The mean IPSS scores at baseline, 1week and 3 months were 23.3 (12-31), 14.5 (3-29), and 7.2 (2-21). The mean QoL scores at the same time points were 4.8 (3-6), 3.9 (2-6) and 1.2 (1-5). Conclusions: We found PAE to be safe without evidence of bladder or rectal injury. Initial symptomatic outcomes were promising with improvements in IPSS and QoL scores. Further prospective studies are needed to validate our findings.
TUESDAY: Scientific Sessions
3:27 PM
Abstract No. 266
Prostatic arterial embolization for refractory and recurrent hematuria: a single-center experience I. Kably1, S. Bhatia2, G. Narayanan1, S. Narayanan3; 1 University of Miami, Miami, FL; 2University of Miami, Davie, FL; 31987, Coral Gables, FL Purpose: Refractory hematuria due to bladder or prostate disease is a potentially life threatening condition and can present a major therapeutic challenge. The purpose of this study was to evaluate the efficacy of PAE for refractory or recurrent hematuria from the lower urinary tract (LUT). Materials: We retrospective reviewed the charts of 23 patients (mean age of 70.5 years) referred, between December 2013 and September 2016, for refractory or recurrent hematuria nonresponsive to conservative therapy. 24 embolization procedures were performed on 23 patients. The primary endpoint was duration until cessation of hematuria following PAE. Secondary endpoints included hemoglobin and prostate specific antigen level; prostate size before and after the procedure; blood transfusion requirements, follow-up duration and complications. Results: The immediate clinical success rate was 100%. Bilateral PAE was performed in 18 cases, PAE with bladder artery embolization (BAE) in 3 cases, and unilateral PAE in 3 cases. Cessation of hematuria was initially noted in all patients within an average of 1.4 days (range 1–7 days). The mean post-embolization follow-up was 182 days (range 45 days–15 months). At a mean follow-up of 6 months (range 30 days–15 months) four patients with cancer had recurrent hematuria, requiring a repeat procedure in one patient. Hemoglobin level significantly improved (p ¼ 0.0005) during the first week.
’
JVIR
Significant decreases were observed in post-procedural blood transfusion requirement (p ¼ 0.002) prostate size (p ¼ 0.006), and PSA level (p ¼ 0.17). 5 patients in retention were catheter free after an average interval of 48 days (range 1 to 180 days). Two patient presented with perineal pain and were managed conservatively. During follow-up, 3 patients died of underlying disease without recurrent bleeding. Conclusions: PAE is an efficacious therapy for hematuria originating from the LUT, with the best safety profile in the published literature.
3:36 PM
Abstract No. 267
Clinical outcomes and quality of life measures in the use of prostate artery embolization for prostates 480 g: a single-center experience
S. Bhatia1, V. Sinha2, C. Gomez3, S. Harward4, G. Narayanan1; 1University of Miami, Department of Interventional Radiology, Miami, FL; 2University of Miami, Miller School of Medicine, Miami, FL; 3University of Miami, Department of Urology, Miami, FL; 4The Dartmouth Institute for Health Policy and Clinical Practice, Arlington, MA Purpose: Surgical options for management of large prostate adenomas (480 g) are limited and entail significant morbidity. 1 We evaluate the efficacy and quality of life (QOL) impact of prostate artery embolization (PAE) for the treatment of benign prostatic hyperplasia (BPH) for prostates 480 g. Materials: Patient demographics, International Prostate Symptom Score (IPSS), QOL, prostate volume assessed by MRI, and post-void residual (PVR) volume were evaluated as part of an IRB-approved retrospective analysis at a single institution. Exclusion criteria included patients with active urinary tract infection, renal failure, or severe atherosclerosis. Patients with a history of recurrent infection and urinary retention were excluded from the analysis. Results: 43 patients underwent PAE for BPH with prostate size 480 g. Mean patient age was 67.4 years, mean baseline IPSS was 25.2, and mean prostate volume was 133.9 g. Mean (range) baseline QOL was 4.7 (2-6). At 1 month, 3 months, and 6 months, QOL score improved to 1.3 (po0.005), 0.83 (po0.005), and 0.92 (po0.005), respectively; IPSS decreased to 7.3 (po0.005), 5.9 (po0.005), and 5.7 (po0.005), respectively. At 3 months of follow up, mean prostate volume had decreased to 88.5 g (po0.005). PVR values at baseline and 3 months were 211.6mL and 46.6mL (po0.005) respectively. Three major complications were noted: two patients had urinary retention post PAE requiring indwelling catheter for 7 days and one patient was admitted for IV antibiotics to manage urosepsis. Conclusions: PAE achieved a clinically and statistically significant reduction in prostate size, IPSS score and PVR volume, and an improvement in QOL in patients with prostates 4 80 g. These findings suggest that PAE can be a valuable treatment option for BPH among men with 480 gram prostates with a favorable safety profile, when the conventional surgical options are limited and carry significant morbidity.