Super-selective prostatic artery emboliation for high-risk elderly patients with hyperplasia of prostate associated with acute urinary retention

doi:10.3877/cma.j.issn.1674-3253.2024.03.007

Abstract

Abstract:

Objective

To evaluate the safety and effectiveness of superselective prostatic artery embolization (PAE) for treating benign prostatic hyperplasia (BPH) with acute urinary retention (AUR) in high-risk elderly patients.

Methods

A retrospective analysis was conducted on 35 cases of BPH patients with AUR treated at Nanjing Drum Tower Hospital from August 2018 to October 2021. The patients' age ranged from 70 to 88 years (mean age 78±5 years), and all patients had one or more significant comorbidities involving vital organs such as the heart, brain, and lungs. Using digital subtraction angiography and C-arm cone-beam CT dual localization, super-selective prostate artery embolization was performed. The clinical evaluation criterion was the absence of AUR within 1 year after the removal of the urinary catheter. Additionally, comparisons were made for prostate volume, maximum urinary flow rate (Q_max), international prostate symptom score (IPSS), quality of life score (QOL), undisturbed sleep time (HUS), and national institutes of health chronic prostatitis symptom index (NIH-CPSI) at 1, 3, 6, and 12 months postoperatively.

Results

The surgeries were successful for all 35 patients, and there were no serious adverse reactions postoperatively. Urinary catheters were removed one week after surgery, with 30 cases recovering spontaneous urination, while 5 cases experienced recurrent urinary retention and continued catheterization. In these 5 cases, self-urination was reestablished after catheter removal within 1 to 2 weeks. None of the patients experienced AUR again within one month to the first year postoperatively. Compared to the preoperative status, there was a significant reduction in prostate volume and nocturia frequency after surgery, symptoms such as IPSS, QOL, HUS, and NIH-CPSI showed significant enhancement (P<0.001). Compared to one month after surgery, Q_max gradually increased over time (P<0.001).

Conclusion

The utilization of PAE in the management of BPH accompanied by AUR is both safe and efficacious. Therefore, PAE can be considered as a viable therapeutic option for elderly or high-risk BPH patients.

Key words: Benign prostatic hyperplasia, NIH-CPSI, Acute urinary retention, Prostatic artery embolism, Interventional radiology

Xinghe Pan, Xiang Dong, Haiyang Yang, Xuebin Zhang, Weidong Gan. Super-selective prostatic artery emboliation for high-risk elderly patients with hyperplasia of prostate associated with acute urinary retention[J]. Chinese Journal of Endourology(Electronic Edition), 2024, 18(03): 237-242.

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References 24

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评估指标	IPSS（分）	QOL（分）	HUS（h）	NIH-CPSI（分）	夜尿（次）	前列腺体积（ml）	Q_max（ml/s）^*
PAE术前	27.50±4.35	5.38±0.58	2.02±0.76	33.46±2.59	4.50±1.41	118.25±38.39	-
术后1个月	13.75±5.88	2.92±1.14	2.73±1.38	16.42±4.84	3.13±1.31	099.29±29.57	5.34±2.89
t值	16.35	10.55	-2.76	18.65	8.88	5.03	-
P值	<0.001	<0.001	<0.001	<0.001	<0.001	<0.001	-
术后3个月	10.42±4.76	2.33±1.05	2.88±1.45	12.21±3.81	2.50±1.26	085.95±28.09	7.63±1.25
t值	19.36	14.31	-3.25	33.78	8.28	4.75	-6.65
P值	<0.001	<0.001	<0.001	<0.001	<0.001	<0.001	<0.001
术后6个月	07.38±4.25	1.48±1.10	3.02±1.54	07.75±4.43	2.19±1.33	077.25±28.60	9.09±2.39
t值	21.26	17.95	-3.58	33.00	8.58	4.35	-6.93
P值	<0.001	<0.001	<0.001	<0.001	<0.001	<0.001	<0.001
术后12个月	06.35±4.07	1.03±0.95	3.52±1.25	06.33±4.15	2.12±1.52	71.27±18.4	10.69±3.580
t值	22.86	21.49	-3.73	38.97	8.38	4.04	-4.41
P值	<0.001	<0.001	<0.001	<0.001	<0.001	<0.001	<0.001

评估指标	IPSS（分）	QOL（分）	HUS（h）	NIH-CPSI（分）	夜尿（次）	前列腺体积（ml）	Q_max（ml/s）^*
PAE术前	27.50±4.35	5.38±0.58	2.02±0.76	33.46±2.59	4.50±1.41	118.25±38.39	-
术后1个月	13.75±5.88	2.92±1.14	2.73±1.38	16.42±4.84	3.13±1.31	099.29±29.57	5.34±2.89
t值	16.35	10.55	-2.76	18.65	8.88	5.03	-
P值	<0.001	<0.001	<0.001	<0.001	<0.001	<0.001	-
术后3个月	10.42±4.76	2.33±1.05	2.88±1.45	12.21±3.81	2.50±1.26	085.95±28.09	7.63±1.25
t值	19.36	14.31	-3.25	33.78	8.28	4.75	-6.65
P值	<0.001	<0.001	<0.001	<0.001	<0.001	<0.001	<0.001
术后6个月	07.38±4.25	1.48±1.10	3.02±1.54	07.75±4.43	2.19±1.33	077.25±28.60	9.09±2.39
t值	21.26	17.95	-3.58	33.00	8.58	4.35	-6.93
P值	<0.001	<0.001	<0.001	<0.001	<0.001	<0.001	<0.001
术后12个月	06.35±4.07	1.03±0.95	3.52±1.25	06.33±4.15	2.12±1.52	71.27±18.4	10.69±3.580
t值	22.86	21.49	-3.73	38.97	8.38	4.04	-4.41
P值	<0.001	<0.001	<0.001	<0.001	<0.001	<0.001	<0.001

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