Abstract / Summary
Background: /Objectives: Prostatic artery embolization (PAE) with n-butyl cyanoacrylate (NBCA) glue-lipiodol mixture has several advantages over PAE with microspheres for the treatment of symptomatic benign prostatic hyperplasia (BPH). However, distal penetration of glue-lipiodol in intraprostatic vasculature is often not possible and proximal-only prostatic artery (PA) occlusion with glue may fail to induce significant prostatic infarction. To mitigate this limitation, the authors applied and evaluated SEquential utilization of MIcrospheres and GLUE for PAE (SEMIGLUE-PAE). Meth-ods: For SEMIGLUE-PAE, embolization began with microspheres (100-300μm) with the microcatheter tip at the distal extraprostatic part of the PA; intraprostatic advancement of the microcatheter and injection of additional microspheres was then at-tempted. When flow stasis in intraprostatic branches was observed, embolization continued with small aliquots (0.1ml) of glue-lipiodol mixture (1:8) with the same initial position of microcatheter tip, until the distal one half (to two thirds) of the extraprostatic PA was filled with the mixture. SEMIGLUE-PAE was applied in 20 consecutive patients with symptomatic BPH. Short-term improvement in imaging and clinical parameters and safety were evaluated.
Results: Clinical success rate was 95%, 90% and 83.6% at 3, 6 and 12 months post SEMIGLUE-PAE, respectively. Three months post SEMIGLUE-PAE, mean reduction of prostate volume was 32.4% (p< 0.01) and mean improvement of international prostate symptom score was 61.2% (p< 0.01). Mean percentage of prostatic infarction (measured within 24 hours post PAE and compared to baseline PV) was 45.7%. Minor (only) complications were encountered in 4/20 patients.
Conclusions: SEMIGLUE-PAE seems to be safe, effective and feasible, especially for operators with limited experience in embolization with glue.