Phương pháp nút động mạch điều trị tăng sinh lành tính tuyến tiền liệt có thể tích lớn: kết quả trên 32 trường hợp (>80 GAM)

Prostatic arterial embolization for the treatment of benign prostatic hyperplasia due to large: result in 32 case (>80 gam)

SUMMARY

Background: Currently, large prostate size (>80 g) of benign prostatic hyperplasia still pose technical challenges for surgical treatment with complication such as: hemorrhage, endoscopy syndrome,…

Objective: to explore the safety and efficacy of prostatic arterial embolization as an alternative treatment for patients with lower urinary tract symptoms due to large benign prostatic hyperplasia.

Methods: A total of 32 patients with prostates >80 g were included in the study; all were failure of medical treatment and unsuited for surgery. Prostatic arterial embolization was performed using combination of 250 μm and 400μm particles in size, under local anaesthesia by a unilateral femoral approach. Clinical follow-up was performed using the international prostate symptoms score (IPSS), quality of life (QoL), peak urinary flow (Qmax), post-void residual volume (PVR), international index of erectile function short form (IIEF-5), prostatic specific antigen (PSA) at 1, 3, 6 month and prostatic volume measured by magnetic resonance imaging at 3 month after intervention.

Results: Prostatic arterial embolization was technically successful in 32 patients (100%). Follow- up data were available for the those patients with a mean follow-up of 6 months. The clinical improvements in IPSS, QoL, Qmax, PVR, and PV at 6 month was 74.1 %, 152%, 68.7%, 92.6 %, and 35.5% (3 months), respectively. The mean IPSS (pre PAE vs post PAE 27.5 vs 7.1; P < 0.01), the mean QoL (4.7 vs 1.7; P < 0.01 ), the mean Qmax (7.5 vs 18.9; P < 0.01), the mean PVR (65 vs 20.3; P < 0.01), and PV (98.0 vs 65.0, with a mean reduction of 33.6 %; P < 0.01 ) at 3 month after PAE were significantly different with respect to baseline. The mean IIEF-5 was not statistically different from baseline. No major complications were noted.

Conclusions: Prostatic arterial embolization is a safe and effective treatment method for patients with with lower urinary tract symptoms due to large volume. Prostatic arterial embolization may play an important role in patients in whom medical therapy has failed, who are not candidates for any surgical treatment.

Keywords: Benign prostatic hyperplasia (BPH), Prostatic artery embolization (PAE), large prostate size