Embolization for benign prostatic hyperplasia yields strong outcomes

Washington-An embolization technique employing 100-µm or 200-µm polyvinyl beads delivered through the femoral artery and into prostatic arteries to block the latter and shrink prostate volume in men with BPH produces short- and mid-term results equivalent to transurethral resection of the prostate (TURP), Portuguese researchers reported.

"This research suggests that embolization may be a good alternative to surgery in many patients with BPH. The indications for embolization appear to be the same as those for TURP," first author Luis Campos Pinheiro, MD, PhD, told Urology Times.

The data accrued to date indicate that the treatment provides symptomatic relief similar to that seen with TURP while avoiding complications such as urinary tract infection, strictures, incontinence, urinary retention, sexual dysfunction, and blood loss, according to Dr. Campos Pinheiro, who is associate professor of urology at New University of Lisbon, Lisbon, Portugal.

Better results with smaller beads

The larger 200-µm non-spherical beads were injected into the first 14 patients, but the next 42 patients received 100-µm beads.

"We found that we could obtain better results with the 100-µm beads. We have yet to thoroughly study the mechanisms, but it appears that the smaller beads produce better results because they lodge deeper in the vasculature of the prostate," Dr. Campos Pinheiro said.

In the 52 patients considered to be clinical successes, the mean prostate volume decreased by 28.1%, PSA fell by 26.1%, peak urinary flow (Qmax) increased by 6.1 points, the International Prostate Symptom Score decreased by 9.8 points, and quality of life improved by 1.9 points. No patient reported deterioration of sexual function.

There were four complications. One was a case of bladder wall ischemia that was treated surgically. Three patients developed urinary retention and were treated with bladder catheterization for up to 5 days, by which time all cases were resolved.

Conducted via femoral artery

The procedure, performed under local anesthesia, lasts from 30 minutes to 2 hours and is conducted via the femoral artery using a cobra-shaped catheter (C2F5) and a micro-catheter. In the current study, 52 of the patients were discharged between 4 and 8 hours following the procedure, and the remaining four were released within 18 hours.

Challenges remain, said Dr. Campos Pinheiro. It would be beneficial to be able to separate those patients most likely to benefit from the procedure from those least likely to benefit. He said that the majority of patients show substantial improvement, but there is a small group whose improvement is negligible. Contraindications for the procedure might include small-volume prostates and arterial sclerosis.

"This procedure is still in research," he said. "I think that embolization will be a technique that can be applied to patients with early-stage BPH. It may or may not be as good as surgery, but it is easy on the patients and substantially relieves symptoms in many of them."