Patient selection and counseling before prostatic arterial embolization

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30 Citations (Scopus)

Abstract

Prostatic arterial embolization (PAE) for relief of lower urinary tract symptoms (LUTS) in patients with prostate enlargement or benign prostatic hyperplasia (PE or BPH) is an experimental procedure with promising preliminary results. Patient evaluation and selection before PAE is paramount to improve technical and clinical results. Our inclusion criteria for PAE include: male patients, age>40 years, prostate volume>30 cm(3) and diagnosis of PE or BPH with moderate to severe LUTS refractory to medical treatment for at least 6 months (International Prostate Symptom Score [IPSS]>18, or quality of life [QoL]>3, or both) or with acute urinary retention refractory to medical therapy. Exclusion criteria include: malignancy (based on pre-embolization digital rectal and transrectal ultrasound [TRUS] examinations and prostate specific antigen [PSA] measurements with positive biopsy), large bladder diverticula, large bladder stones, chronic renal failure, tortuosity and advanced atherosclerosis of a) iliac or b) prostatic arteries on pre-procedural computed tomographic angiography (CTA), active urinary tract infection and unregulated coagulation parameters. Approximately one-third of the patients seen initially on consultation satisfy the criteria to be selected for PAE after undergoing the pre-procedural patient evaluation workflow. In the pre-procedural consultation patients are informed of all possible therapeutic options for LUTS with the investigational nature of the procedure being strongly reinforced. The major advantage of PAE relies on the minimally-invasive nature of the technique with minimal morbidity and rapid recovery,and it being performed as an outpatient procedure. However, the experimental nature and uncertain clinical outcome should also be weighed before opting for PAE. All these considerations should be explained to the patient and discussed during the informed consent before PAE.

Original languageEnglish
Pages (from-to)270-275
Number of pages6
JournalTechniques in vascular and interventional radiology
Volume15
Issue number4
DOIs
Publication statusPublished - Dec 2012

Keywords

  • Counseling
  • Embolization, Therapeutic
  • Humans
  • Lower Urinary Tract Symptoms
  • Male
  • Patient Selection
  • Predictive Value of Tests
  • Prostate
  • Prostatic Hyperplasia
  • Risk Factors
  • Severity of Illness Index
  • Treatment Outcome
  • Urodynamics
  • Workflow
  • Journal Article
  • Review

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