Yale University School of Medicine, Department of Radiology and Biomedical Imaging, New Haven, CT.
Yale University School of Medicine, Department of Urology, New Haven, CT.
Tech Vasc Interv Radiol. 2020 Sep;23(3):100688. doi: 10.1016/j.tvir.2020.100688. Epub 2020 Oct 6.
Prostate artery embolization (PAE) has been shown to be safe and effective at treating lower urinary tract symptoms (LUTS), urinary retention, and hematuria caused by benign prostatic hyperplasia (BPH). To distinguish from other causes of these symptoms, a multidisciplinary evaluation by a urologist and interventional radiologist should include a complete history to screen for any nonprostate causes of LUTS. The International Prostate Symptom Score is a useful objective measure to quantify the patient's urinary complaints. A physical exam should be performed to evaluate a patient's candidacy for angiography, and baseline laboratory evaluation should ensure that the patient's coagulation and kidney function are adequate. In certain situations, patients may benefit from cystoscopy and urodynamic evaluation to ensure their symptoms are related to BPH. A review of the patient's imagining can be the most important component of the evaluation of a patient prior to PAE, because a patient's gland size is often a primary driver of what procedural options available are to him. Men with small glands (≤30 mL) can be treated with several of the available minimally invasive transurethral procedures, but larger glands (≥80-120 mL) may be limited to holmium laser enucleation of prostate, thulium laser enucleation of prostate, surgical prostatectomy, or PAE, depending on institutional practice patterns. Secondary considerations include medical comorbidities, the risks for sexual side effects, the risk for bleeding, and the possible adverse events associated with the procedure, which are all low for PAE. Most patients suffering from symptomatic BPH resulting in LUTS, retention, or hematuria will benefit from PAE.
前列腺动脉栓塞术 (PAE) 已被证明在治疗良性前列腺增生 (BPH) 引起的下尿路症状 (LUTS)、尿潴留和血尿方面是安全有效的。为了与这些症状的其他原因区分开来，泌尿科医生和介入放射科医生的多学科评估应包括完整的病史，以筛查 LUTS 的任何非前列腺原因。国际前列腺症状评分是一种有用的客观测量方法，可量化患者的排尿抱怨。应进行体格检查以评估患者进行血管造影的候选资格，并且基线实验室评估应确保患者的凝血和肾功能充足。在某些情况下，患者可能受益于膀胱镜检查和尿动力学评估，以确保其症状与 BPH 有关。在 PAE 之前，对患者的影像学进行回顾可能是评估患者的最重要组成部分，因为患者的腺体大小通常是决定他可获得的治疗方案的主要因素。腺体较小的男性 (≤30 mL) 可以接受几种现有的微创经尿道手术治疗，但腺体较大的男性 (≥80-120 mL) 可能仅限于钬激光前列腺剜除术、铥激光前列腺剜除术、前列腺切除术或 PAE，具体取决于机构的实践模式。次要考虑因素包括合并症、性功能副作用风险、出血风险以及与该程序相关的可能不良事件，这些风险对于 PAE 都较低。大多数因 LUTS、潴留或血尿而导致有症状的 BPH 的患者将从 PAE 中受益。
