Department of Urology, Mutah University of Medicine, Karak, Jordan.
Department of Medico-Surgical Biotechnologies, Department of Urology, Sapienza University of Rome, Latina, Italy.
Int J Clin Pract. 2020 Mar;74(3):e13454. doi: 10.1111/ijcp.13454. Epub 2019 Dec 10.
Among minimally invasive procedures for treating benign prostate hyperplasia (BPH) prostate artery embolisation (PAE) is described as safe and effective. Aim of this study is to report our results, focusing on sexual outcomes (erectile and ejaculatory functions sparing) of PAE in patients suffering from bladder outlet obstruction (BOO) secondary to BPH.
We prospectively enrolled and submitted to PAE subjects suffering from BOO secondary to BPH. All patients were not suitable for surgery or declined invasive approaches. All subjects were preoperatively and postoperatively (3, 6, 12 and 18 months after) evaluated by urinary flowmetry, post voiding residual volume, prostate volume, serum PSA levels, International Index of Erectile Function, International Prostate Symptom Score and QoL scores.
PAE was performed in 147 patients (mean age 72.5 y.o.). PAE was technically successful in all patients. The procedure lasted a mean time of 94.3 minutes, with a mean fluoroscopic time of 42.5 minutes. Twelve months follow-up data were available for all patients, while 126 patients (85%) completed the 18 months follow up. At 12 months follow up, the mean IPSS and QoL scores significantly decreased, and all the objective parameters (mean Qmax, PVR and prostate volume) reported a significant improvement. A total of 130 patients (88.5%) at 12 months reported the antegrade ejaculation preserved, and a slight not significant improvement of IIEF scores. The 18 months after PAE outcomes confirmed the significant improvement of all the variables evaluated (even for PSA values and IIEF scores). No major complications occurred.
Our results evidence prostate artery embolisation as highly feasible and safe procedure with interesting outcomes. In particular, in our study PAE reported promising results in preserving antegrade ejaculation and erectile function. Our data are in line with the literature, confirming how PAE reduces obstructive symptoms in BPH patients not suitable or refusing standard surgical approaches.
前列腺动脉栓塞术 (PAE) 是治疗良性前列腺增生 (BPH) 的微创方法之一，已被描述为安全有效的。本研究旨在报告我们的结果，重点关注因 BPH 导致膀胱出口梗阻 (BOO) 而接受 PAE 治疗的患者的性功能结局（保留勃起和射精功能）。
我们前瞻性地招募了因 BPH 导致 BOO 而接受 PAE 的患者。所有患者均不适合手术或拒绝接受有创治疗。所有患者均在术前和术后（PAE 后 3、6、12 和 18 个月）进行尿流率、剩余尿量、前列腺体积、血清 PSA 水平、国际勃起功能指数、国际前列腺症状评分和生活质量评分的评估。
147 例患者接受了 PAE（平均年龄 72.5 岁）。所有患者均成功完成了 PAE 手术。手术平均持续时间为 94.3 分钟，平均透视时间为 42.5 分钟。所有患者均获得了 12 个月的随访数据，而 126 例患者（85%）完成了 18 个月的随访。12 个月随访时，IPSS 和 QoL 评分均显著降低，所有客观参数（平均最大尿流率、剩余尿量和前列腺体积）均显著改善。12 个月时，共有 130 例（88.5%）患者报告保留了顺行射精，IIEF 评分略有改善但无统计学意义。PAE 后 18 个月的结果证实了所有评估变量的显著改善（甚至 PSA 值和 IIEF 评分也有所改善）。未发生重大并发症。
我们的研究结果表明，前列腺动脉栓塞术是一种可行且安全的治疗方法，具有良好的效果。特别是在我们的研究中，PAE 报告在保留顺行射精和勃起功能方面具有良好的效果。我们的数据与文献一致，证实了 PAE 如何降低不适合或拒绝标准手术治疗的 BPH 患者的梗阻症状。
