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In one study, Joao Martins Pisco, M.D., of St. Louis Hospital in Lisbon, Portugal, and colleagues performed prostate artery embolization (PAE) on 1,000 men.
The investigators evaluated all patients over the short term (one, three, and six months), 807 patients over the medium term (every six months between six months and three years), and 406 patients over the long term (every year after three years). "We found that, over the short term, 89 percent of patients were better. For the medium term, we found that 82 percent of patients improved, and over the long term, 78 percent were better," Pisco said. The investigators did another analysis of 112 patients who also suffered acute urinary retention before undergoing PAE and found that 94.6 percent of these patients had their catheter removed between two and 90 days after treatment. Over longer-term follow-up, over 75 percent had no recurrence of their acute urinary retention symptoms. "There are a number of complications tied to open surgery as compared to PAE, including incontinence, impotence, and other ailments, which are less likely with PAE. I strongly believe in four to five years, this will be standard treatment for benign prostatic hyperplasia," Pisco said.
"Benign prostatic hyperplasia or BPH is so common that it's been said that all men will have an enlarged prostate if they live long enough, said João Martins Pisco, M.D., chief radiologist at Hospital Pulido Valente and director of interventional radiology at St. Louis Hospital, both in Lisbon, Portugal.
"I believe that a minimally invasive interventional radiology treatment-prostatic artery embolization or PAE-will be the future treatment for benign prostatic hyperplasia or men's noncancerous enlarged prostates." Today's most used therapy is surgical transurethral resection of the prostate (or TURP). "While the gold standard treatment for enlarged prostates has been TURP, minimally invasive prostatic artery embolization is safe, performed under local anesthesia and has comparable clinical results-without TURP's limitations and risks," said Pisco. TURP can be performed only on prostates smaller than 60 cubic centimeters (cc); there is no size limitation for PAE treatment, said Pisco, who is also a professor at the Faculty of Medical Sciences, New University of Lisbon. "The best results are obtained on patients with prostates larger than 60 cubic centimeters and with very severe symptoms," he added. "Pelvic arterial embolization may be the only feasible and effective treatment for benign prostatic hyperplasia in those men who cannot have TURP due to the size of their prostate (80+ cubic centimeters) or because it is inadvisable for them to undergo general anesthesia," said Pisco. "Such symptoms can have significant negative impact in quality of life, leading many men to seek treatment," said Pisco. "We need innovative technologies, such as prostatic artery embolization, to continue to improve outcomes and minimize patient discomfort and morbidity when managing enlarged prostates," he added. The men were followed for more than nine months (on average), and PAE was found to be technically successful in 98.5 percent of the patients-with 77 men showing "excellent" improvement, six men "slight improvement" (but needing no medications) and one experiencing no improvement (due to receiving an incomplete embolization), Pisco added. Two hours after PAE, most men were passing urine less frequently. It was impossible to embolize both prostate arteries in the men showing "slight improvement" due to advanced atherosclerosis, said Pisco. "There is no sexual dysfunction following prostatic artery embolization, and a quarter of our patients report that sexual function improved after the procedure," added Pisco. How TURP is performed BPH can be treated by TURP, a procedure in which a scope is inserted through the penis and the prostate is removed piece by piece, or surgery through an abdomen incision (prostatectomy). During surgery, a man generally undergoes general anesthesia and needs to spend several days in a hospital. Major complications are frequent, such as blood loss, severe pain, sexual dysfunction, impotence, retrograde ejaculation, urinary incontinence, pain, infections and urethral stricture, said Pisco. Other treatments for enlarged prostate Other treatments for enlarged prostrates-besides prostatic artery embolization, TURP and prostatectomy-include watchful waiting, drugs (to relax muscles near prostate to ease symptoms or help shrink the prostate) and other minimally invasive therapies (such as transurethral needle ablation and laser surgery), which have major disadvantages, such as providing less effective improvement in symptoms, poorer durability of symptomatic benefit, and greater risk of continued catheterization and reoperation. "Additional research is needed to explain why some patients improve better than others," said Pisco.
The early and medium term results of this study into prostatic artery embolization or PAE are significant because they show PAE achieves comparable clinical results to that of the common surgical procedure "TURP", short for transurethral resection of the prostate, without the surgical risks, such as sexual dysfunction, urinary incontinence, retrograde ejaculation and blood loss, said study author Dr João Martins Pisco, chief radiologist at Hospital Pulido Valente and director of interventional radiology at St Louis Hospital, both in Lisbon.
Dr. João Martins Pisco, an interventional radiologist at St. Louis Hospital in Lisbon, Portugal, stated that UFE will probably be a first-line treatment option in the future even for women who wish to conceive and are unable due to the presence uterine fibroids.
João Pisco, M.D.
St. Louis Hospital