Interventional Radiology and Endovascular Surgery Department, Radiology Institute, University of Sao Paulo Medical School, Dr. Enéas de Carvalho Aguiar Avenue, 255, Cerqueira César, 05403-000, São Paulo, SP, Brazil.
Urology Department, University of Sao Paulo Medical School, Dr. Enéas de Carvalho Aguiar Avenue, 255, Cerqueira César, 05403-000, São Paulo, SP, Brazil.
Cardiovasc Intervent Radiol. 2020 Apr;43(4):613-619. doi: 10.1007/s00270-019-02398-0. Epub 2020 Jan 2.
The aim of this study is to compare the improvements in irritative versus obstructive symptoms of the International Prostate Symptom Score (IPSS) after prostatic artery embolization (PAE) in patients with benign prostatic hyperplasia (BPH).
Between 2010 and 2018, 186 patients underwent PAE in a single center and 174 patients were retrospectively selected. The inclusion criteria were symptoms due to BPH, refractory to pharmacological treatment and IPSS ≥ 8. The mean age of the patients was 63.7 ± 7.2 years, the mean prostate volume 89.5 ± 42.5 cm, and the mean IPSS 19.0 ± 6.2 points. Patient data were reviewed at baseline, 3, 12 and 24 months and compared using the ANOVA mixed models and the Tukey's multiple comparison test.
Obstructive subscores dropped more significantly than irritative subscores (p < 0.0001). The mean decrease in each IPSS item was frequency 2.4 (83%); urgency 0.8 (87%); nocturia 1.3 (49%); incomplete emptying 2.6 (83%); intermittency 2.3 (91%); weak stream 2.9 (82%); straining 1.6 (91%). The area under the curve for baseline obstructive scores was 0.7 (p = 0.006) and 0.59 (p = 0.182) for irritative scores. The most common BPH clinical manifestations include irritative and/or obstructive symptoms, the latter usually more prevalent. The IPSS drop observed after PAE suggests that it acts predominantly over obstructive symptoms (p < 0.0001).
Although a predominant improvement in obstructive symptoms may be observed after PAE, nocturia complaints may require special attention. The severity of baseline obstructive symptoms may significantly predict clinical outcomes.
本研究旨在比较前列腺动脉栓塞术（PAE）治疗良性前列腺增生（BPH）后国际前列腺症状评分（IPSS）中刺激性与阻塞性症状的改善情况。
2010 年至 2018 年，在单中心进行了 186 例患者的 PAE，回顾性选择了 174 例患者。纳入标准为 BPH 引起的症状，药物治疗无效，IPSS≥8。患者平均年龄为 63.7±7.2 岁，前列腺平均体积为 89.5±42.5cm³，平均 IPSS 为 19.0±6.2 分。患者数据在基线、3、12 和 24 个月时进行了回顾，并使用方差混合模型和 Tukey 多重比较检验进行了比较。
阻塞性评分下降明显大于刺激性评分（p<0.0001）。每个 IPSS 项目的平均下降值为：频率 2.4（83%）；急迫性 0.8（87%）；夜尿症 1.3（49%）；不完全排空 2.6（83%）；间歇性 2.3（91%）；尿流弱 2.9（82%）；用力排尿 1.6（91%）。基线阻塞性评分的曲线下面积为 0.7（p=0.006），刺激性评分的曲线下面积为 0.59（p=0.182）。最常见的 BPH 临床表现包括刺激性和/或阻塞性症状，后者通常更为常见。PAE 后观察到的 IPSS 下降表明，它主要作用于阻塞性症状（p<0.0001）。
尽管 PAE 后可能观察到阻塞性症状的明显改善，但夜尿症的抱怨可能需要特别关注。基线阻塞性症状的严重程度可能显著预测临床结局。
