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: Prostatic artery embolization (PAE) is a minimally invasive angiographic procedure used to treat hematuria caused by benign prostatic hyperplasia (BPH). However scarce outcomes data exist on PAE for gross hematuria. This study presents medium-term safety and efficacy data for PAE to treat gross hematuria caused by BPH.
Methods: 66 patients undergoing PAE in the setting of gross hematuria from December 2013 through August 2018 were reviewed retrospectively. Patients were included if cystoscopy found a large bleeding prostate and upper tract evaluation was negative. Patients were excluded for other hematuria sources (infection, stones or cancer)(n=11). 16 patients were treated for severe hematuria (SH) requiring continuous bladder irrigation (CBI) (age 79.8Â±8.8, Charlson comorbidity index (CCI) 5.8Â±2.5, prostate gland volume (PGV) 326Â±171mL). 39 patients had gross hematuria (GH), but were embolized to treat urinary retention (17 patients: age 76.7Â±9.0, CCI 4.1Â±1.7, PGV 191Â±79mL), or lower urinary tract symptoms (22 patients: age 74.0Â±8.2, CCI 3.8Â±1.6, PGV 232Â±149mL). Follow-up occurred at 1, 3, 6, 12, 24, and 36 months. Adverse events were recorded using Clavien-Dindo classification.
Results: 55 patients were included for study (no technical failures). 13/16 (81%) SH patients had CBI stopped 2-3 days after PAE and remained free of gross hematuria (mean follow-up=500Â±501 days). 2 (13%) SH patients had recurrent hematuria requiring prostatic fulguration 52 and 60 days after PAE. 1 patient had recurrent hematuria 165 days later from new bladder tumor. 34/37 (92%) GH patients remained free of gross hematuria after PAE (mean follow-up=306Â±234 days). There were 2 deaths < 30 days after PAE (1 from unrelated warfarin toxicity, 1 from urosepsis in an immunocompromised stage 4 cancer patient). There were 7 (13%) grade 2 urinary infections and 5 (9%) self-limited grade 1 adverse events. 26/29 (89%) patients with chronic catheters were successfully voiding within 2 months after PAE.
Conclusions: For patients with severe hematuria requiring CBI or gross hematuria caused by BPH, PAE is a safe, effective, and durable treatment. Embolization decreases glandular blood flow to stop bleeding, but also causes necrosis and shrinkage that relieves bladder outlet obstruction.