Moschouris Hippocrates, Stamatiou Konstantinos
Department of Radiology, General Hospital "Tzanio", Piraeus 18536, Greece.
Department of Urology, General Hospital "Tzanio", Piraeus 18536, Greece.
World J Radiol. 2024 Sep 28;16(9):380-388. doi: 10.4329/wjr.v16.i9.380.
Prostatic artery embolization (PAE) is a promising but also technically demanding interventional radiologic treatment for symptomatic benign prostatic hyperplasia. Many technical challenges in PAE are associated with the complex anatomy of prostatic arteries (PAs) and with the systematic attempts to catheterize the PAs of both pelvic sides. Long procedure times and high radiation doses are often the result of these attempts and are considered significant disadvantages of PAE. The authors hypothesized that, in selected patients, these disadvantages could be mitigated by intentionally embolizing PAs of only one pelvic side.
To describe the authors' approach for intentionally unilateral PAE (IU-PAE) and its potential benefits.
This was a single-center retrospective study of patients treated with IU-PAE during a period of 2 years. IU-PAE was applied in patients with opacification of more than half of the contralateral prostatic lobe after angiography of the ipsilateral PA (subgroup A), or with markedly asymmetric prostatic enlargement, with the dominant prostatic lobe occupying at least two thirds of the entire gland (subgroup B). All patients treated with IU-PAE also fulfilled at least one of the following criteria: Severe tortuosity or severe atheromatosis of the pelvic arteries, non-visualization, or visualization of a tiny (< 1 mm) contralateral PA on preprocedural computed tomographic angiography. Intraprocedural contrast-enhanced ultrasonography (iCEUS) was applied to monitor prostatic infarction. IU-PAE patients were compared to a control group treated with bilateral PAE.
IU-PAE was performed in a total 13 patients (subgroup A, = 7; subgroup B, = 6). Dose-area product, fluoroscopy time and operation time in the IU-PAE group (9767.8 μGy∙m, 30.3 minutes, 64.0 minutes, respectively) were significantly shorter (45.4%, 35.9%, 45.8% respectively, < 0.01) compared to the control group. Clinical and imaging outcomes did not differ significantly between the IU-PAE group and the control group. In the 2 clinical failures of IU-PAE (both in subgroup A), the extent of prostatic infarction (demonstrated by iCEUS) was significantly smaller compared to the rest of the IU-PAE group.
In selected patients, IU-PAE is associated with comparable outcomes, but with lower radiation exposure and a shorter procedure compared to bilateral PAE. iCEUS could facilitate patient selection for IU-PAE.
前列腺动脉栓塞术（PAE）是一种有前景但技术要求较高的介入放射学治疗方法，用于治疗有症状的良性前列腺增生。PAE中的许多技术挑战与前列腺动脉（PA）的复杂解剖结构以及双侧盆腔PA插管的系统性尝试有关。手术时间长和辐射剂量高往往是这些尝试的结果，被认为是PAE的显著缺点。作者推测，在特定患者中，通过仅对一侧盆腔的PA进行栓塞，这些缺点可能会得到缓解。
描述作者进行单侧PAE（IU-PAE）的方法及其潜在益处。
这是一项对2年内接受IU-PAE治疗的患者进行的单中心回顾性研究。IU-PAE应用于同侧PA血管造影后对侧前列腺叶显影超过一半的患者（A组），或前列腺明显不对称增大、优势前列腺叶至少占整个腺体三分之二的患者（B组）。所有接受IU-PAE治疗的患者还至少符合以下标准之一：盆腔动脉严重迂曲或严重动脉粥样硬化、术前计算机断层血管造影显示对侧PA未显影或显影为微小（<1mm）。术中应用对比增强超声（iCEUS）监测前列腺梗死情况。将IU-PAE患者与接受双侧PAE治疗的对照组进行比较。
共对13例患者进行了IU-PAE（A组7例；B组6例）。与对照组相比，IU-PAE组的剂量面积乘积、透视时间和手术时间（分别为9767.8μGy∙m、30.3分钟、64.0分钟）显著缩短（分别缩短45.4%、35.9%、45.8%，P<0.01）。IU-PAE组与对照组的临床和影像学结果无显著差异。在IU-PAE的2例临床失败病例中（均在A组），与IU-PAE组的其他患者相比，前列腺梗死范围（通过iCEUS显示）明显较小。
在特定患者中，IU-PAE与双侧PAE相比，疗效相当，但辐射暴露更低，手术时间更短。iCEUS有助于IU-PAE的患者选择。
