Recurrence of Lower Urinary Tract Symptoms Following Prostate Artery Embolization for Benign Hyperplasia: Single Center Experience Comparing Two Techniques

Francisco Cesar Carnevale, Airton Mota Moreira, Sardis Honoria Harward, Shivank Bhatia, Andre Moreira de Assis, Miguel Srougi, Giovanni Guido Cerri, Alberto Azoubel Antunes

To compare recurrence of lower urinary tract symptoms (LUTS) recurrence at 12 months following original prostate artery embolization (oPAE) or "proximal embolization first, then embolize distal" (PErFecTED) PAE for benign prostatic hyperplasia (BPH). 105 consecutive patients older than 45 years, with prostate size greater than 30 cm(3), International Prostate Symptom Score (IPSS) ≥ 8, quality of life (QoL) index ≥ 3, and refractory status or intolerance of medical management were prospectively enrolled between June 2008 and August 2013. The study was IRB-approved, and all patients provided informed consent. Patients underwent oPAE or PErFecTED PAE and were followed for at least 12 months. Technical success was defined as bilateral embolization and clinical success (non-recurrence) was defined as removal of the Foley catheter in patients with urinary retention, IPSS < 8 and QoL index < 3 at 12 months of follow-up. Nonparametric statistics were used to compare the study groups due to the size of the study population and distributions of clinical data. 97 patients had 12-month data and were categorized as oPAE without recurrence (n = 46), oPAE with recurrence (n  = 13), PErFecTED without recurrence (n  = 36), or PErFecTED with recurrence (n  = 2). Recurrence was significantly more common in oPAE patients (χ (2), p = 0.026). Unilateral embolization was significantly associated with recurrence among patients who underwent oPAE (χ (2), p = 0.032). Both oPAE and PErFecTED PAE are safe and effective methods for treatment of LUTS, but PErFecTED PAE is associated with a significantly lower rate of symptom recurrence.