Endoluminal Therapy and Diagnosis Unit, Jesús Usón Minimally Invasive Surgery Centre, Cáceres, Spain.
Jesús Usón Minimally Invasive Surgery Centre, Cáceres, Spain.
Br J Radiol. 2022 Aug 1;95(1136):20220243. doi: 10.1259/bjr.20220243. Epub 2022 Jul 7.
To compare the technical efficacy and safety between prostatic artery occlusion (PAO) with ethylene vinyl alcohol copolymer (EVOH) and prostatic artery embolizsation (PAE) with microspheres in a canine model.
17 adult male beagles underwent PAO (n = 7) with Onyx-18 or PAE (n = 10) with microspheres (300-500 µm). To evaluate the primary outcomes (technical efficacy and safety), MRI evaluations were performed immediately before and 1 week, 2 weeks, and 1 month after procedures to document prostate volume (PV); and all dogs were inspected for procedure-related complications during 1 month follow-up. The secondary outcomes included the prostate ischaemia size detected by MRI and recanalisation of prostatic artery by follow-up angiography. Differences between groups were statistically analysed.
Both procedures were bilaterally successful in all animals. Compared with PAE, the mean fluoroscopy time (23.80 vs 36.24 min, p = 0.014) and radiation dose (68.19 vs 125.26 mGy, p = 0.003) were significantly less in PAO procedure. The mean percentage of PV change significantly decreased in both groups at 2 weeks (30.71% vs 37.89%) and 1 month (56.41% %vs 55.56%) after PAO and PAE respectively), without significant differences between groups at either time point. No major complications were observed except one animal after PAO with transient haematuria and acute urinary retention. The mean prostate ischaemia induced by PAO was significant greater compared with PAE at 1 week (43.44% vs 18.91%, p=0.001). PAO with EVOH is technically feasible and with comparable efficacy and safety with PAE. There are possible benefits to PAO over PAE.
A new technical modification of the PAE consisting of the use of liquid embolic agent to occlude the prostatic artery trunk and its branches has been developed in pre-clinical study, showing to be an effective and safe procedure which can induce a significant prostate shrinkage for the management of symptomatic benign prostatic hyperplasia in patients. In addition, the findings have showed a similar therapeutic effect comparable with the conventional PAE using microspheres.
比较犬模型中前列腺动脉闭塞（PAO）与乙烯-乙烯醇共聚物（EVOH）和前列腺动脉栓塞（PAE）与微球的技术疗效和安全性。
17 只成年雄性比格犬分别行 PAO（n=7）用 Onyx-18 或 PAE（n=10）用 300-500μm 的微球。为评估主要结局（技术疗效和安全性），在术前及术后 1 周、2 周和 1 个月进行 MRI 评估，记录前列腺体积（PV）；所有犬在 1 个月随访期间检查与手术相关的并发症。次要结局包括 MRI 检测到的前列腺缺血大小和随访血管造影显示的前列腺动脉再通。对组间差异进行统计学分析。
两组动物均双侧手术成功。与 PAE 相比，PAO 术中透视时间（23.80 分钟 vs 36.24 分钟，p=0.014）和辐射剂量（68.19 毫戈瑞 vs 125.26 毫戈瑞，p=0.003）显著减少。PAO 组术后 2 周（30.71% vs 37.89%，p=0.014）和 1 个月（56.41% vs 55.56%，p=0.014）时 PV 变化的平均百分比均显著降低，两组间在任何时间点均无显著差异。除 1 只行 PAO 的动物出现短暂血尿和急性尿潴留外，无重大并发症。PAO 诱导的平均前列腺缺血在术后 1 周（43.44% vs 18.91%，p=0.001）时明显大于 PAE。PAO 联合 EVOH 在技术上是可行的，与 PAE 相比具有相似的疗效和安全性。PAO 可能优于 PAE。
在临床前研究中，开发了一种新的前列腺动脉栓塞技术改良，即使用液体栓塞剂闭塞前列腺动脉干及其分支，结果表明该技术是一种有效且安全的方法，可显著缩小前列腺体积，从而有效治疗有症状的良性前列腺增生患者。此外，研究结果显示，该技术的治疗效果与使用微球的常规前列腺动脉栓塞术相似。
