Date Added: 10/06/2015
Date Updated: 14/09/2017
Prostatic artery embolisation to treat benign prostatic hyperplasia
Specialties: Mens Health & Sexual Health - Oncology & radiotherapy - Renal disease & urology
Technology Type: Procedures
Stage of development: Other
Stage of EAA: Assessment Complete
Prostatic artery embolisation (PAE) was first introduced in the 1970s as a technique to control major bleeding associated with prostatectomy and prostate biopsies.(1-3) The therapeutic benefits of this technique on benign prostatic hyperplasia (BPH) were later realised (4) and animal studies later ensued.(5, 6) PAE was first investigated as an alternative treatment for benign prostatic hyperplasia in 2010.(7)
The aim of prostatic artery embolisation for the treatment of BPH is to starve the prostate gland of its blood supply and nutrients leading to ischaemic necrosis of part of the gland.(8) As a result, the prostate gland shrinks in size thereby improving benign prostatic hyperplasia and its associated symptoms of lower urinary tract symptoms (LUTS).
PAE is a non-invasive technique performed by interventional radiologists, in consultation with urologists, under local anaesthesia and sedation. The procedure is performed using a left or right femoral artery approach. Fine microcatheters are guided through the internal iliac and vesical arteries allowing the super-selective catheterisation of the small prostatic arteries.(9) Embolisation involves releasing microparticles into the prostatic arteries to block the vessels that feed the prostate gland.(9)
Several types of embolisation agents have been reported in published prostatic artery embolisation trials which include:
â€¢ Tris-acryl gelatin microspheres7, 10
â€¢ Non-spherical polyvinyl alcohol (PVA) particles (11-14)
â€¢ Spherical embolic agents: hydrogel microspheres with a proprietary coating (15)
Various sized embolising particles have been used. One study has compared different polyvinyl alcohol particle sizes on the outcome for PAE.(16) Embolising particle sizes used in published prostatic artery embolisation trials which include:
â€¢ 300â€“500 Î¼m microspheres,(10, 17)
â€¢ 80â€“180 Î¼m or 180â€“300 Î¼m nonspherical polyvinyl alcohol (PVA) particles,(11-13, 16, 18, 19)
â€¢ 100â€“400 Î¼m spherical embolic agents.(15)
A pelvic angiography using non-ionic contrast medium is often used to make an initial assessment of the anatomy of the iliac and prostatic arteries. The blood supply of the prostate is then assessed using a selective angiography. Contrast medium is injected manually to ensure the correct positioning of the tip of the micro-catheter. The embolising agent is delivered in a solution of contrast medium and saline under the guidance of a fluoroscopy.
The National Institute for Health and Care Excellence (NICE) in the UK has published an interventional procedures programme20 and a procedure guidance (9) of prostatic artery embolisation for benign prostatic hyperplasia. These guidelines recommend that the procedure should only be performed in the context of research and that consideration of the patient should be undertaken by a multidisciplinary team (including an interventional radiologist and urologist).