Medium and long term outcome of prostatic arteries embolization, for patients with benign prostatic hyperplasia_ results in 460 cases

Purpose: To evaluate the medium and long term clinical outcome of prostatic arteries embolization (PAE) in 460 patients with benign prostatic hyperplasia (BPH). Materials and Methods: PAE was performed in 460 patients with BPH and moderate to severe lower urinary tract symptoms (LUTS) refractory to medical therapy for at least 6 months between March 2009 and July 2013. PAE was performed with non-spherical polyvinyl alcohol (PVA) particles in 372 patients, 300to 500-mm tris-acryl microspheres (Embosphere) in 40 patients, 300to 500-mm spherical PVA particles (Bead Block) in 20 patients and 400-mm Polyzenecoated microspheres (Embozene) in 18 patients. PAE outcomes were evaluated based on International Prostate Symptom Score (IPSS), quality of life (Qol) and International Index Erectile Function (IIEF) questionnaires, prostate volume (PV), prostate specific antigen (PSA), and peak urinary flow rate (Qmax) changes from baseline. Clinical success was considered when there was reduction of the total IPSS score at least 25% and r 15, Qol reduction of at least one point or r 3 and no need of medical therapy or any other treatment. Results: There were 8 (1.7%) technical failures and 29 patients were lost to follow up. All 423 controlled patients were followed up at 1, 3, and 6 months (short term) and every 6 months up to 3 years (mid term), 118 over 3 years (long term). From the last group, 27 patients have been followed over 4 years. A statistically significant improvement of all evaluated parameters was observed, over time. The cumulative rates were 81.3% at short term, 72.7% at medium term and 70.1% at long term. There were 2 major complications: a small bladder wall ischemia treated by surgery and a lasting pelvic pain for 3 months. Both patients remained without sequela. There was not any case of sexual dysfunction. Conclusion: PAE is a safe, well tolerated, and efficient outpatient procedure, for patients with BPH and moderate to severe LUTS, good mid-term and long term results and no sexual dysfunction.