Prostatic artery embolism is an interventional radiological procedure which can be done on TURP-NON eligible patient for BPH, it involves entrance to Prostatic Artery through the femoral artery- and embolizing w/small bubbly material.
My question is- Due to ischemic necrosis of Hyperplasic prostatic tissue there will be some kind of erosion of that tissue from rest of prostate--is it possible to see that necrotic tissue can block flow of urine- leading an obstruction of urine outflow?
My other question is-- perfusion of pelvic structures are quite complicated and involves lots of small anastomosis'-- after disabling flow of the Prostatic artery, what are the chances of getting bladder neck into an ischemic necrosis--due to possible anastomosis'?
I thank you all for your answers and your comments.
Hi Sal,
PAE for symptomatic patients with BPH has been widely performed with low complication rates, however, there is a potential for severe complications, including technical and clinical treatment failures. Long catheter time after the procedure and repeated catheterization are seen frequently due to failed trials of voiding without catheter. We have experienced such worse outcome during conducting a comparative RCT between PAE and green light laser prostate ablation.
Furthermore, PAE has many limitations, including lack of significant improvement in IPSS or Qmax in 25% of patients, unknown long-term durability, need for high dose ionizing radiation dose and contrast material for procedural guidance, can not be technically achieved on one or both sides as a result of atherosclerosis, small artery size, and/or tortuosity and collateral circulation may be present, and maintains vascularity.
To date, no high-quality multi-center RCTs have been published on safety, efficacy, and cost-effectiveness of PAE for BPH. Most of the studies are of low quality due to their case series design. Therefore, advantages of PAE must be weighed against the risk of technical and clinical failures requiring a second intervention.
Regarding your question, bladder neck will not be affected by a selective technique done by an expertise.
Regards
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