Impact of Prostatic Artery Embolization in Patients with Enlarged True Middle Lobes
1Clinic for diagnostic and Interventional Radiology and Neuroradiology, MediClin Robert Janker Klinik, 53129 Bonn, Germany
2Department for Urology, Urology Centre Friedensplatz, 53111 Bonn, Germany
DOI: 10.31083/j.jomh1811216 Vol.18,Issue 11,November 2022 pp.1-6
Published: 30 November 2022
*Corresponding Author(s): Attila Kovács E-mail: email@example.com
Background: Prostatic artery embolization (PAE) is an emerging minimal-invasive therapy of benign prostatic hyperplasia (BPH), able to reduce the prostatic volume (PVol) and the IPP. The presence of a true middle lobe (TML) is associated with bladder outlet obstruction (BOO), causing lower urinary tract symptoms (LUTS). In this study we investigate the effect of PAE in TML improvement in patients with LUTS. Methods: A retrospective analysis was done of 47 men treated with PAE from April 2015 to September 2021. The volume of the TML, IPP, and PUA were measured on MRI prior and 2 months after PAE. Successful devascularization of the TML was evaluated by contrast-enhanced MRI (ceMRI) 48 hours after therapy. Results: The TML was successfully embolised technically in 72%. After two months, the total volume of the prostate (PVol) was reduced by 25.8 ± 13.3% (from 72.1 ± 39.8 cc to 52.5 ± 27.9 cc; p < 0.000). Following a technically successful PAE of the TML, the TMLVol decreased by 32.1 ± 21.5% (from 10.6 ± 16.1 cc to 7.2 ± 13.1 cc; p < 0.000), and the IPP was reduced by 29.3 ± 15.5% (from 16.3 ± 7.4 mm to 11.9 ± 6.6 mm; p < 0.000). In contrast, after a technically incomplete devascularisation of the TML the TMLVol decreased by only 7.2 ± 17.7% (from 8.4 ± 9.3 cc to 7.5 ± 8.9 cc; p = 0.089), and the IPP was reduced by only 10.9 ± 8.8% (from 16.4 ± 7.3 mm to 14.6 ± 6.7 mm; p = 0.003). The currecture of the PUA after a successful and after an incomplete embolization of the TML was comparable with 11.6 ± 7.6 and 12.2 ± 9.4, respectively (in both p < 0.001). Conclusions: Our study firstly shows that PAE is able to reduce TML volume. Furthermore, PAE is able to reduce the IPP even if caused by a TML.
benign prostatic hyperplasia; lower urinary tract symptoms; prostatic artery embolisation; minimal-invasive therapy; true middle lobe
Willi Zhou,Peter Bischoff,Herbert Hanitzsch,Matthias Schmidt,Andreas Schäfer,Ayoub El-Mansouri,Attila Kovács. Impact of Prostatic Artery Embolization in Patients with Enlarged True Middle Lobes. Journal of Men's Health. 2022. 18(11);1-6.
 Kang DH, Lee JY, Hah YS, Chung DY, Lee DH, Cho KS, et al. Correlation of prostatic urethral angle with the severity of urinary symptom and peak flow rate in men with small prostate volume. PLoS ONE. 2014; 9: e104395.
 Kovács A. Interventional therapy in benign conditions of the prostate. Radiology. 2020; 60: 54–62.
 Tchaou M, Hounkpevi JM, Gbande P, Padja E, Kpatcha T, Gba-doe E, et al. Intravesical Prostate Protrusion (IPP) versus Mid-dle Lobe Volume on Ultrasonography in Assessing the Impact of Benign Prostatic Hyperplasia. Open Journal of Radiology. 2020; 10: 193–202.
 Kovács A. Prostate artery embolization (PAE): Technique and results. Radiology. 2017; 57: 641–651. (In German)
 Teichgräber U, Aschenbach R, Diamantis I, von Rundstedt F, Grimm M, Franiel T. Prostate Artery Embolization: Indication, Technique and Clinical Results. RoFo. 2018; 190: 847–855.
 Cornelis FH, Bilhim T, Hacking N, Sapoval M, Tapping CR, Carnevale FC. CIRSE Standards of Practice on Prostatic Artery Embolisation. CardioVascular and Interventional Radiology. 2020; 43: 176–185.
 Kovács A, Bücker A, Grimm M, Habermann CR, Katoh M, Massmann A, et al. Position Paper of the German Society for Interventional Radiology (DeGIR) on Prostatic Artery Embolization. RoFo. 2020; 192: 835–846.
 Franco JV, Jung JH, Imamura M, Borofsky M, Omar MI, Esco-bar Liquitay CM, et al. Minimally invasive treatments for lower urinary tract symptoms in men with benign prostatic hyperpla-sia: a network meta-analysis. Cochrane Database of Systematic Reviews. 2021; 7: CD013656.
 Gratzke C, Bachmann A, Descazeaud A, Drake MJ, Maders-bacher S, Mamoulakis C, et al. EAU Guidelines on the As-sessment of Non-neurogenic Male Lower Urinary Tract Symp-toms including Benign Prostatic Obstruction. European Urol-ogy. 2015; 67: 1099–1109.
 Gul ZG, Kaplan SA. BPH: why do Patients Fail Medical Ther-apy? Current Urology Reports. 2019; 20: 40.
 Sun F, Crisóstomo V, Báez-Díaz C, Sánchez FM. Prostatic Artery Embolization (PAE) for Symptomatic Benign Prostatic Hyperplasia (BPH): Part 2, Insights into the Technical Ratio-nale. CardioVascular and Interventional Radiology. 2016; 39: 161–169.
 Oelke M, Bschleipfer T, Hofner K. Fake News BPH - what is really true! Urologe - Ausgabe A. 2019; 58: 271–283. (In Ger-man)
 Rosier PF, de la Rosette JJ. Is there a correlation between prostate size and bladder-outlet obstruction? World Journal of Urology. 1995; 13: 9–13.
 Eckhardt MD, van Venrooij GE, van Melick HH, Boon TA. Prevalence and bothersomeness of lower urinary tract symptoms in benign prostatic hyperplasia and their impact on well-being. Journal of Urology. 2001; 166: 563–568.
 Oelke M, De Wachter S, Drake MJ, Giannantoni A, Kirby M, Orme S, et al. A practical approach to the management of nocturia. International Journal of Clinical Practice. 2017; 71: e13027.
 Sountoulides P, Mutomba WF. Feeling of incomplete bladder emptying: a definition with clinical implications. LUTS: Lower Urinary Tract Symptoms. 2019; 11: 85–85.
 Abt D, Hechelhammer L, Müllhaupt G, Markart S, Güsewell S, Kessler TM, et al. Comparison of prostatic artery embolisa-tion (PAE) versus transurethral resection of the prostate (TURP) for benign prostatic hyperplasia: randomised, open label, non-inferiority trial. British Medical Journal. 2018; 361: k2338.
 Lin Y, Amouyal G, Thiounn N, Pellerin O, Pereira H, Del Giu-dice C, et al. Intra-vesical Prostatic Protrusion (IPP) can be Re-duced by Prostatic Artery Embolization. Cardiovascular and In-terventional Radiology. 2016; 39: 690–695.
 Yu SCH, Cho CCM, Hung EHY, Zou J, Yuen BTY, Shi L, et al. Thickness-to-Height Ratio of Intravesical Prostatic Protrusion Predicts the Clinical Outcome and Morbidity of Prostatic Artery Embolization for Benign Prostatic Hyperplasia. Journal of Vas-cular and Interventional Radiology. 2019; 30: 1807–1816.
 Sun F, Lucas-Cava V, Sánchez-Margallo FM. Clinical predic-tive factors in prostatic artery embolization for symptomatic be-nign prostatic hyperplasia: a comprehensive review. Transla-tional Andrology and Urology. 2020; 9: 1754–1768.
 Markar SR, Vidal-Diez A, Sounderajah V, Mackenzie H, Hanna GB, Thompson M, et al. A population-based cohort study exam-ining the risk of abdominal cancer after endovascular abdominal aortic aneurysm repair. Journal of Vascular Surgery. 2019; 69: 1776–1785.e2.
 Monastiriotis S, Comito M, Labropoulos N. Radiation expo-sure in endovascular repair of abdominal and thoracic aortic aneurysms. Journal of Vascular Surgery. 2015; 62: 753–761.
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