Yu Simon Chun Ho, Cho Carmen, Hung Esther, Wang Defeng, Chiu Peter, Yee Chi Hang, Ng Anthony
Department of Imaging and Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong, c/o Rm. 2A061, 2/F, Main Clinical Block and Trauma Centre, 30-32 Ngan Shing St., Shatin, New Territories, Hong Kong SAR; Vascular and Interventional Radiology Foundation Clinical Science Center, Prince of Wales Hospital, The Chinese University of Hong Kong, c/o Rm. 2A061, 2/F, Main Clinical Block and Trauma Centre, 30-32 Ngan Shing St., Shatin, New Territories, Hong Kong SAR.
Department of Imaging and Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong, c/o Rm. 2A061, 2/F, Main Clinical Block and Trauma Centre, 30-32 Ngan Shing St., Shatin, New Territories, Hong Kong SAR; Vascular and Interventional Radiology Foundation Clinical Science Center, Prince of Wales Hospital, The Chinese University of Hong Kong, c/o Rm. 2A061, 2/F, Main Clinical Block and Trauma Centre, 30-32 Ngan Shing St., Shatin, New Territories, Hong Kong SAR.
J Vasc Interv Radiol. 2017 Aug;28(8):1167-1176. doi: 10.1016/j.jvir.2017.04.004. Epub 2017 May 13.
It is hypothesized that intra-arterial administration of verapamil is a safe and effective way to reverse the flow in intraprostatic anastomoses to extraprostatic arteries without compromising treatment outcomes in prostatic artery embolization (PAE) for benign prostatic hypertrophy (BPH).
A prospective study of 62 prostate sides in 31 consecutive patients (median age, 66 y; range, 60-71 y) with symptomatic BPH was undertaken. Median prostate volume was 72.4 mL (range, 48.8-85.8 mL), median International Prostate Symptom Score was 21 (range, 15-23), and median urine peak flow rate was 4 mL/s (range, 2-6 mL/s). The arterial anastomoses were classified as types I-III according to vascular morphology. Treatment safety was assessed in terms of adverse events and complications, and treatment effectiveness was assessed in terms of success rate of angiographic flow reversal.
The PAE procedure was successfully completed in all 31 patients (100%). Adverse events in both groups were transient and mild and did not necessitate prolonged hospitalization. There was no clinical evidence of any significant nontarget ischemic complication in either group. Intraprostatic anastomosis was diagnosed in 19 of 31 patients (61.3%) and 22 of 62 prostate sides (35.5%). Success rates of verapamil treatment were 88.9% overall (20 of 22) and 100% (19 of 19) in type II and III anastomoses. There was no difference between the treatment group and the control group in clinical, urologic, and imaging outcomes of PAE.
Intra-arterial verapamil treatment was probably safe and effective in causing flow reversal in type II and III intraprostatic anastomoses and in preventing ischemic complications in PAE for BPH without compromising PAE outcomes.
据推测，在良性前列腺增生（BPH）的前列腺动脉栓塞术（PAE）中，动脉内注射维拉帕米是一种安全有效的方法，可使前列腺内吻合口血流逆向流入前列腺外动脉，且不影响治疗效果。
对31例连续性有症状BPH患者（中位年龄66岁；范围60 - 71岁）的62个前列腺侧叶进行了一项前瞻性研究。前列腺中位体积为72.4 mL（范围48.8 - 85.8 mL），国际前列腺症状评分中位值为21（范围15 - 23），尿流率峰值中位值为4 mL/s（范围2 - 6 mL/s）。根据血管形态将动脉吻合口分为I - III型。从不良事件和并发症方面评估治疗安全性，从血管造影血流逆转成功率方面评估治疗有效性。
所有31例患者（100%）的PAE手术均成功完成。两组的不良事件均为短暂且轻微的，无需延长住院时间。两组均无任何明显非靶器官缺血并发症的临床证据。31例患者中的19例（61.3%）以及62个前列腺侧叶中的22个（35.5%）诊断为前列腺内吻合口。维拉帕米治疗的总体成功率为88.9%（22例中的20例），II型和III型吻合口的成功率为100%（19例中的19例）。PAE的临床、泌尿外科和影像学结果在治疗组和对照组之间无差异。
动脉内注射维拉帕米治疗可能安全有效，可使II型和III型前列腺内吻合口血流逆转，并在不影响PAE治疗效果的情况下预防BPH的PAE中的缺血并发症。
