Presentation Authors: Raj Ayyagari*, Taylor Powell, Julius Chapiro, Lawrence Staib, New Haven, CT, Shivank Bhatia, Miami, FL, Toby Chai, New Haven, CT, Steven Schoenberger, New London, CT, Ralph Devito, New Haven, CT
Introduction: This study presents 2-year safety and efficacy data for prostatic artery embolization (PAE) to treat lower urinary tract symptoms (LUTS) caused by benign prostatic hyperplasia (BPH).
Methods: 84 patients undergoing PAE due to LUTS caused by BPH from April 2014 through August 2018 were retrospectively reviewed. 78 of these met inclusion criteria (age>44, LUTS without retention, failed medical therapy, International Prostate Symptom Score (IPSS)>12, Quality of Life score (QOL)>2). 6 were then excluded for bladder pathology. Subjects (n=72) had mean age 71.5Â±9.1, mean Charlson comorbidity index (CCI) 3.4Â±1.7, mean gland volume (PGV) 167Â±107mL. After PAE, subjects were evaluated at 1, 3, 6, 12 and 24 months. Comparisons to baseline used T-tests (PGV, post void residual (PVR)) and Wilcoxon signed rank tests (IPSS, QOL). Associations between IPSS, QOL or PVR and age, CCI, PGV, or median lobe enlargement were analyzed by linear regression. Adverse events were recorded using Clavien-Dindo classification.
Results: Mean improvements in IPSS and QOL at 1, 3, 6, 12 and 24 months after PAE are shown in Figure 1 (P < 0.001 for all). Mean improvements in PVR and PGV at 3, 6, 12 and 24 months are shown in Figure 2 (P < 0.001 for all, except P=NS at 24 months). Cohort sizes diminish due to ongoing cohort maturation, dementia preventing symptom quantification, and incomplete follow-up, with 4 (6%) technical failures. There was no association between age, CCI, PGV, or median lobe enlargement and IPSS, QOL or PVR at 3, 6 or 12 months after PAE (P=NS). 2 patients had grade 2 urinary infections (with 1 death due to immunocompromise); 1 patient had painful necrotic tissue resected at 8 months; 10 patients had grade 1 adverse events.
Conclusions: PAE safely and effectively produced sustained meaningful improvements in LUTS, PVR, and PGV at 2 years, independent of age, CCI, PGV, or median lobe enlargement. BPH patients excluded from transurethral procedures by these factors may undergo PAE and expect significant symptom improvement.