Prostatic artery embolization (PAE) using polyethylene glycol microspheres: safety and efficacy in 81 patients

Purpose: To evaluate the safety and efficacy of prostatic artery embolization (PAE) using polyethylene glycol microspheres (PEGM) in patients with lower urinary tract symptoms secondary to benign prostatic hyperplasia (BPH). Materials and methods: This multicentric prospective study enrolled 81 patients who underwent PAE with 400 ± 75 µm PEGM (HydroPearl®, Terumo, Japan). Results from baseline and 1-, 3-, 6-, and 12-month follow-ups were assessed for subjective outcomes including International Prostate Symptoms Score (IPSS), Quality of life (QoL), and International Index of Erectile Function, and objective outcomes such as peak urinary flow (Qmax) and post-void residual volume (PVR). The visual analogue scale, satisfaction questionnaire, prostatic volume, and prostatic specific antigen levels were also evaluated. Complications were documented using the modified Clavien-Dindo classification. Results: Technical success was obtained in all patients. Clinical success was achieved in 78.5% of patients. Before PAE, 54.3% of patients had an indwelling catheter which was removed in 75% of them after procedure. A statistically significant decrease was observed in IPSS and QoL from baseline to 12 months (20.14 vs 5.89; 4.8 vs 0.63, P <.01), respectively. Objective outcomes also showed a statistically significant improvement in Qmax (+ 114.9%; P <.01), achieving a maximum urinary flow of 14.2 mL/sec, and PVR (decrease 58%; P <.05) at 12 months. Minor complications (Clavien-Dindo grades I-II) occurred in 13.6% of patients, without major complications observed. Conclusion: PAE with PEGM is safe and effective treatment in patients with symptomatic BPH, with a significant improvement in both subjective and objective outcome

Estudio comparativo de la embolización y la oclusión de la arteria prostática para el manejo de la hiperplasia prostática benigna en un modelo canino

Programa de Doctorado en Biomarcadores de Salud y Estados Patológicos por la Universidad de ExtremaduraLa hiperplasia prostática benigna (HPB) es una enfermedad frecuente en hombres cuya prevalencia incrementa con la edad, y causa síntomas del tracto urinario inferior (STUI). La embolización de la arteria prostática (EAP) es una técnica mínimamente invasiva novedosa como tratamiento alternativo en pacientes con HPB sintomática. Ha demostrado ser efectiva y segura para mejorar STUI con una baja tasa de complicaciones. La EAP induce una isquemia prostática que resulta en una necrosis y, consecuentemente, un encogimiento prostático. Sin embargo, la EAP tiene inconvenientes como la embolización no dirigida y la recanalización de las arterias prostáticas embolizadas. Por ello, se ha desarrollado una nueva modificación técnica llamada oclusión de la arteria prostática (OAP) consistente en la oclusión del tronco de la arteria prostática y sus principales ramas usando un agente embolizante líquido (Onyx®). La OAP podría inducir un efecto de castración intraprostático basado en la apoptosis isquémica y la privación de andrógenos intraprostáticos, dando un encogimiento prostático. Esta tesis tiene como objetivo probar el éxito técnico de la EAP con microesferas y de la OAP con Onyx® en un modelo canino de HPB espontánea, evaluar los mecanismos subyacentes en ambos procedimientos, y determinar la eficacia y la seguridad entre ellos. Los resultados han demostrado la viabilidad técnica, la efectividad para inducir isquemia prostática y, posteriormente, encogimiento de próstata, y la seguridad con baja tasa de complicaciones asociadas a ambos procedimientos. Sin embargo, se necesitan más investigaciones para evaluar los beneficios potenciales de la OAP en estudios preclínicos y clínicos.The benign prostatic hyperplasia (BPH) is a frequent disease in men whose prevalence increases with aging, and causes lower urinary tract symptoms (LUTS). Prostatic artery embolización (PAE) is a novel minimally invasive technique used successfully in clinical practice as an alternative treatment in patients with symptomatic BPH which has demonstrated to be effective and safe to improve LUTS with low complication rate associated. PAE induces a prostate ischemia which results in a necrosis and, consequently, a prostate shrinkage. However, PAE has inherent drawbacks such as non-target embolization and recanalization of embolized prostatic arteries. To overcome these issues, further technical modifications of conventional PAE are needed. It has been developed a new technical modification called prostatic artery occlusion (PAO) consisting of a occlusion of prostatic artery trunk and its main branches using a liquid embolic agent (Onyx®). PAO might induce an intraprostatic castration effects based on ischemic apoptosis and deprivation of intraprostatic androgens, with the subsequent prostate shrinkage. This thesis aims to test the technical success in either PAE using microspheres or PAO using Onyx® in a canine spontaneous BPH model, and to assess the underlying mechanisms in both procedures, as well as to determine the technical efficacy and safety between them. The results obtained have demonstrated the technical feasibility, the effectiveness to induce prostatic ischemia and consequently prostate shrinkage, and the safety with low complication rate associated to both procedures. However, further investigations are needed to evaluate the potential benefits of PAO in both preliminary study and clinical practice.Financiados por la Consejería de Economía, Ciencia y Agenda Digital de la Junta de Extremadura a través de los proyectos IB18129, GR18199, GR21201 y cofinanciados por el Fondo Europeo de Desarrollo Regional ''Una manera de hacer Europa”