Kisilevzky N, Faintuch S
Endovascular Center, Sao Paulo, Brazil.
Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
Clin Radiol. 2016 Sep;71(9):876-82. doi: 10.1016/j.crad.2016.05.003. Epub 2016 Jun 11.
To identify predictive factors of clinical success after prostatic artery embolisation (PAE) for patients with acute urinary retention (AUR) secondary to benign prostatic hyperplasia (BPH).
Twenty-four patients with long-term indwelling urinary catheters (duration: 8±3 months) underwent PAE. Factors such as patient age, duration of urinary retention, prostate volume decrease, volume of ischaemic prostate tissue (assessed using magnetic resonance imaging [MRI]), and embolisation technique were studied as potential predictors of clinical success of PAE, defined as the ability to remove the urinary catheter (allowing spontaneous voiding) within 60 days of PAE.
Bilateral embolisation was performed in 21 patients, and unilateral embolisation was performed in three, due to technical challenges. Length of follow-up was 17 months (range: 3-29). No major complications were encountered. Clinical success was achieved in 15 patients (63%) with prostate volume decreasing 24% versus 16% (p=0.03) in the unsuccessful cases. Thirteen of the 15 successful cases (87%) showed ischaemic areas in the prostate on MRI obtained 30 days after embolisation, but only one unsuccessful case (11%) showed a very small area of ischaemia.
Prostatic ischaemia observed on early post-embolisation MRI appears to be the best predictor of clinical success after PAE in patients with AUR secondary to BPH.
确定良性前列腺增生（BPH）继发急性尿潴留（AUR）患者行前列腺动脉栓塞术（PAE）后临床成功的预测因素。
24例长期留置导尿管（时长：8±3个月）的患者接受了PAE。研究了患者年龄、尿潴留时长、前列腺体积减小、缺血性前列腺组织体积（使用磁共振成像[MRI]评估）以及栓塞技术等因素，将其作为PAE临床成功的潜在预测因素，PAE临床成功定义为在PAE后60天内能够拔除导尿管（实现自主排尿）。
21例患者进行了双侧栓塞，3例因技术难题进行了单侧栓塞。随访时长为17个月（范围：3 - 29个月）。未出现重大并发症。15例患者（63%）取得临床成功，成功组前列腺体积减小24%，而未成功组为16%（p = 0.03）。15例成功病例中有13例（87%）在栓塞后30天获得的MRI上显示前列腺有缺血区域，但未成功的病例中只有1例（11%）显示有非常小的缺血区域。
栓塞后早期MRI观察到的前列腺缺血似乎是BPH继发AUR患者行PAE后临床成功的最佳预测因素。
