Hiperplasia Benigna da Próstata - Novo tratamento - Comunicações Livres

41 – SIR 2017 – Washington, March 4 – 8

Outcome of Prostate Artery Embolization for Patients with Benign Prostatic Hyperplasia: 1000 Patients

(Melhor Comunicação entre 1352)

Chemoembolization

40 – SIR 2016 – Vancouver –  GOOD LONG LASTING RESULTS MAY PREDIC PAE AS THE GOLDEN STANDARD TREATMENT FOR BPH – J.M. Pisco, T. Bilhim, L. Fernandes

Good long lasting results may predict PAE as the standard treatment for BPH-page-001

 

39 – Comunicação no CIRSE 2015 (Comunicação Distinta)

Long Term Results of Prostatic Arteries Embolization, For patients with benign prostatic hyperplasia – 240

João Pisco; Tiago Bilhim; Luis C Pinheiro; Jose Pereira; Lucia Fernandes; Nuno Costa; Marisa Duarte; Antonio G Oliveira

1

2

THE SHORT AND MEDIUM TERM RESULTS OF PROSTATIC ARTERIES EMBOLIZATION WITH BEAD BLOCK FOR PATIENTS WITH BENIGN PROSTATIC HYPERPLASIA

Joao Pisco; Tiago Bilhim; Luis C Pinheiro; José Pereira; Lucia Fernandes; Nuno Costa; Marisa Duarte; Antonio G Oliveira

1 the short

2 the short

EMBOLIZATION FOR PATIENTS WITH BENIGN PROSTATIC HYPERPLASIA, VERY LARGE PROSTATE AND MODERATE TO SEREVE LOWER URINARY TRACT SYMPTOMS (LUTS) AS AN ALTERNATIVE TO OPEN SURGERY

Joao Pisco; Luis C Pinheiro; Tiago Bilhim; Lucia Fernandes; Jose Pereira; Nuno Costa; Marisa Duarte; Antonio G Oliveira

1 embolization

2 embolization

Tips and Tricks for difficult PAE procedures

T. Bilhim

2

3

4

The safety and efficacy of prostatic arterial re-embolization for benign prostatic hyperplasia: preliminary results

N.V. Costa, J.A. Pereira, L. Fernandes, T.Bilhim, J.M.Pisco,

1

38 – 27 de Março de 2015

13º aesthetic and anti-aging medicine world congress no Monaco, proferiu a aula: “Benign Prostatic Hyperplasia and the new treatment by embolization”

Prostatic Artery Embolization for Benign Prostatic Hyperplasia-page-001

Prostatic Artery Embolization for Benign Prostatic Hyperplasia-page-002

37 – SIR 2015 – Atlanta

Abstracto classificado como Distinto e incluido nos 10 melhores.

MEDIUM AND LONG TERM OUTCOME OF PROSTATIC ARTERIES EMBOLIZATION, FOR PATIENTS WITH BENIGN PROSTATIC HYPERPLASIA:  RESULTS IN 460 CASES

João Pisco; Tiago Bilhim; Luis C Pinheiro; José Pereira; Lúcia Fernandes; Nuno Costa; Marisa Duarte; António G. Oliveira

JVIR – 2015; 25: 25: S17

Purpose

To evaluate the medium and long term clinical outcome of Prostatic Arteries Embolization (PAE) in 460 patients with Benign Prostatic Hyperplasia (BPH).

Materials and Methods

PAE was performed in 460 patients with BPH and moderate to severe Lower urinary tract symptoms (LUTS) refractory to medical therapy for at least 6 months between March 2009 and July 2013. PAE was performed with non-spherical polyvinyl alcohol (PVA) particles in 372 patients, 300 – to 500 – µm tris-acryl microspheres (Embosphere) in 40 patients, 300 – to 500 – µm spherical PVA particles (Bead Block) in 20 patients and 400 – µm Polyzene – coated microspheres (Embozene) in 18 patients. PAE outcomes were evaluated based on International Prostate Symptom Score (IPSS), Quality of life (Qol) and International Index Erectile Function (IIEF) questionnaires,  prostate volume (PV), prostate specific antigen (PSA) and peak urinary flow rate (Qmax), changes from baseline. Clinical success was considered when there was reduction of the total IPSS score at least 25% and ≤ 15, Qol reduction of at least one point or ≤ 3 and no need of medical therapy or any other treatment.

Results

There were 8 (1.7%) technical failures and 29 patients were lost to follow up. All 423 controlled patients were followed up at 1, 3 and 6 months (short term) and every 6 months up to 3 years (mid term), 118 over 3 years (long term). From the last group, 27 patients have been followed over 4 years. A statistically significant improvement of all evaluated parameters was observed, over time. The cumulative rates were 81.3% at short term, 72.7% at medium term and 70.1% at long term. There were 2 major complications: a small bladder wall ischemia treated by surgery and a lasting pelvic pain for 3 months. Both patients remained without sequela. There was not any case of sexual dysfunction.

Conclusion

PAE is a safe, well tolerated, and efficient outpatient procedure, for patients with BPH and moderate to severe LUTS, good mid-term and long term results and no sexual dysfunction.

Abstracto n.º 299

JVIR 2015;26:25:5 – 136-137

THE PRELIMINARY OUTCOME OF PROSTATIC ARTERIES EMBOLIZATION WITH BEAD BLOCK FOR PATIENTS WITH BENIGN PROSTATIC HYPERPLASIA

 

João Pisco; Tiago Bilhim; Luis C Pinheiro; Lúcia Fernandes; José Pereira; Nuno Costa; Marisa Duarte; António G. Oliveira

PURPOSE – To evaluate the preliminary clinical outcome of Prostatic Arteries Embolization (PAE) with Bead Block in patients with Benign Prostatic Hyperplasia (BPH).

Material and Methods – One hundred fifty patients, with BPH and moderate to severe lower urinary tract symptoms (LUTS) refractory to medical therapy for at least 6 months, underwent PAE with spherical polyvinyl alcohol (PVA) particles – Bead Block 300µm – 500µm, between October 2012 and August 2014. The clinical success was evaluated by clinical improvement of International Prostate Symptoms Score (IPSS), Quality of Life (Qol) and International Index Erectile Function (IIEF) questionnaires and by changes from baseline of Prostate Volume (PV), Prostatic Specific Antigen (PSA), Peak Urinary Flow rate (Qmax) and post-void Residual Volume (PVR) at 1, 3 and every 6 months after PAE.

Results – There was not any technical failure. Three patients was lost to follow up, therefore 146 patients were controlled.  Mean values: procedure time 80.3’; fluoroscopy time 20.5’; radiation 3842.1 dGycm; IPSS / Qol improvement of 10.4 ± 8.1 / 1.58 ± 1.01 points (32.5% / 20.7%). IIEF improvement 1.3 ± 3.0 (19.5%) points; PV reduction 26.2 ±31.5 (28.1%); Qmax improvement 4.7 ± 5.4 mL/s (35%); PSA reduction 3.2 ± 4.2 ng/ml (29.1%). There were 14 initial clinical failures (6.5%). There were 22 patients who were followed over 1 year. In this group of patients there were 2 (9.1%) initial clinical failures, thus the short term clinical success was 90,9%. In the same group of 22 controlled patients over 1 year there was 1 clinical failure at 1 year. Therefore, there was a clinical success over 1 year in 19/22 patients (86.4%). Overall in this group of 150 patients as minor complications there were 2 cases of hematuria, 2 cases of hematospermia, 1 case of slight rectorragia and 1 case of urinary infection. All these adverse events were self controlled. There were no major complications, no sexual dysfunction.

Conclusion – PAE with Bead Block for patients with BPH is an efficient and safe procedure with very good preliminary outcome.

 

Abstrato n.º 300

JVIR 2015; 26:25:S137

Prostatic Arteries Embolization for Benign Prostatic Hyperplasia, with nonspherical PVA particles 150 µm – 250µm and 250 µm -355µm in 90 patients – preliminary results

José Pereira, João Pisco, Tiago Bilhim, Luis C. Pinheiro, Lúcia Fernandes, Nuno Costa, Marisa Duarte, António G. Oliveira

Purpose – To evaluate the outcome of Prostate Arteries Embolization (PAE) with nonspherical PVA particles, in 90 patients with Benign Prostatic Hyperplasia (BPH).

Materials and Methods – Between November 2012 and September 2013 90 patients with BPH and moderate to severe lower urinary tract symptoms (LUTS) refractory to medical therapy for at least 6 months underwent PAE with nonspherical Polyvinyl Alcohol (PVA) particles. By randomization the patients were divided in 2 groups. In group A the patients were embolized with nonspherical PVA particles 150µm – 250µm and in group B the patients were embolized with the same size particles plus 250µm -355µm particles.

Baseline values included mean prostate volume of 74.6 mL, a mean International Prostate Symptom Score (IPSS) of 22.7points, a mean Quality of Life (QoL) score of 4.2 points, a mean PSA of 4.9ng/dL, a mean Post-Void-Residual Urine (PVR) of 140 mL, a mean Peak flow-rate (Qmax) of 12.5mL/s and a mean International Index of Erectile Function (IIEF) of 18 points. There were no significant differences of the different parameters at baseline.

 

Control follow-up was made at 1 and 3 months and included revaluation of baseline clinical parameters.

Results – There were 2 (2.2%) technical failures, 1 in each group. There were 12 patients who were lost to follow up, 5 in group A and 7 in group B, therefore there were 39 patients controlled in group A and 37 in group B. At 1 month after PAE, there were 7 (17.9%) initial failures in group A and 5 (13.5%) in group B. At 6 months after PAE the number of failures were 8 (20.5%) in group A and 6 (16.2%) in group B, therefore the clinical success, at 6 months, was 79.5% in group A and 83.8% in group B. The differences were not statically significant. There was not any major complication.

Conclusion – PAE for BPH with nonspherical PVA 150µm – 250µm and 250µm – 355µm is a safe and efficient outpatient procedure, with good preliminary results. The clinical success was slightly better with a misture of particles of different sizes.

 

Abstracto 346

JVIR 2015; 26:25;S155

The Safety and efficacy of Prostatic Arteries Embolization with polyzene-coated microspheres (Embozene) for Benign Prostatic Hyperplasia – Preliminary results (POSTER)

Nuno Costa, João Pisco, Tiago Bilhim, Luis C. Pinheiro, Lúcia Fernandes, José Pereira, Marisa Duarte, Antonio G. Oliveira

Purpose – To evaluate the short term clinical outcome of prostate artery embolization (PAE) with polyzene-coated microspheres (Embozene) in 20 patients with Benign Prostatic Hyperplasia (BPH)

Materials and Methods – Between June 2011 and July 2013, 20 patients with BPH and moderate to severe lower urinary tract symptoms (LUTS) refractory to medical therapy for at least 6 months, underwent PAE with Embozene 400µm. This prospective study was approved by the institutional review board and an Informed consent for PAE was signed by all participants. The clinical success was evaluated by clinical improvement of International Prostate Symptoms Score (IPSS), Quality of Life (Qol), International Index Erectile Function (IIEF) and by changes of Prostate Volume (PV), Prostatic Specific Antigen (PSA), Peak Urinary Flow rate (Qmax) and post-void Residual Volume (PVR) changes from baseline at 1 and 6 months after PAE. There was technical failure when none of the prostatic arteries was embolized. Clinical success was considered when there was reduction of the total IPSS score of at least 25% and ≤ 15, Qol reduction of at least one point or ≤ 3 and no need of medical therapy or any other treatment.

 

Results – There was not any technical failure. Three patients were lost to follow up, therefore 17 patients were controlled. There were 3 (17.6%) initial clinical failures and clinical success in 14 (14 (83.4%) patients. At 6 months there was another clinical failure, thus the clinical success at 6 months was 76.5 %. There was not any case of sexual dysfunction or any other major complication. There was 1 case of slight hematospermia and 1 case of rectorragia. Both adverse advents were self-controlled.

Conclusion – PAE for BPH with Embozene is a safe and efficient outpatient procedure, with low morbidity, no sexual dysfunction and good preliminary outcome at short term.

36 -RSNA Introduction to Research for International Young Academics

Research Workshop  – RSNA CHICAGO 2014

L. Fernandes, T. Bilhim, J.A. Pereira,  N.V.Costa, M. Duarte, J.M. Pisco Saint Louis hospital/Interventional Radiology, Lisbon/PT

RSNA-research plan-page-001

35 – CIRSE 2014 ( Presented  Poster ) The Safety and Efficacy of Prostatic Arterial Embolization With Bead Block Refractory Benign Prostatic Hyperplasia – A Pilot Study

J.M. Pisco, T. Bilhim, H. Rio Tinto, L. Campos Pinheiro, J.A. Pereira, L. Fernandes, M. Duarte, A.G. Oliveira
Lisbon / PT

1 THE SAFETY 2 THE SAFETY

34  – 43º congresso da sociedade japonesa de radiologia de intervenção – Conferencia

artigod

33 – Março 24 –  SIR 2014 – San Diego

Free Paper Apresentado:

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00002

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32 -RSNA 2013

04-12-2013 Chicago

  • Medium and Long Term Outcome of Prostatic Arterial Embolization to Treat Benign Prostatic HyperplasiaJ.M. Pisco, Lisbon, Portugal; H.A. Rio Tinto; T. Bilhim; L.C. Fernandes; J.A. Pereira; L.C. Pinheiro et al (martinspisco@hslouis.PT)

abstracto

 

Prostatic Arterial Embolization as an Alternative Treatment for Patients with Benign Prostatic Hyperplasia for Patients with Benign Prostatic Hyperplasia and Acute Urinary Retention with Bladder Catheter

L C Fernandes, MD, Valenca, Viana Castelo PORTUGAL; J M Pisco, MD; L C Pinheiro; T Bilhim, MD; H A Rio Tinto, MD; M Duarte, MD; et al. (luci_fernandes@hotmail.com)

PURPOSE

To Access the results of prostatic arterial embolization (PAE) for patients with benign prostatic hyperplasia (BPH) and acute urinary retention (AUR) with bladder catheter.

 

METHOD AND MATERIALS

Fifty-three patients aged 48 to 82 years with BPH, AUR and bladder catheter underwent PAE. Prostate volume and Prostatic Specific Antigen (PSA) were evaluated before PAE. The prostate volume ranged between 44cc and 210cc (mean 95cc). Twenty-six patients had prostates larger than 100cc. PVA particles sized 100µm and 200µm were used as embolic material.

International prostate symptom score (IPSS), Quality of life (QoL), International Index Erectile Function (IIEF), uroflowmetry, (Qmax – peak urinary flow and PVR – post voiding residual volume), Prostatic Specific Antigen (PSA) and prostate volume, were assessed after successful removal of bladder catheter, at 1, 3, 6 and every 6 months thereafter to access the clinical outcome. Patients were evaluated between 3 and 48 months (mean 15 months). It was considered clinical success if the patient could urinate easily after removal of the prostate catheter, the IPSS lower than to 15 and the QoL reduced at least 1 point and no need of medical treatment or any other treatment.

 

RESULTS

All patients were treated as outpatients. There was one technical failure (1.9%) and one patient was lost to follow-up. There was short-term clinical success at 3 months in 45/51 (88.2%). There were 46 (11.8%) patients which bladder catheter could not be removed and were considered short term clinical failures and PAE was repeated. In 4 of them the bladder catheter could be removed, therefore the secondary clinical success was shown in 49/51 (95.1%) patients. The 2 patients which catheter could not be removed were treated by TURP and open prostatectomy, respectively. At 18 months there were 4/51 (7.8%) mid-term clinical failures. Three of them were successfully treated with repeated PAE. The third was treated by open prostatectomy. In 5 patients controlled at long term between 3 and 4 years there was not any recurrence. There was not any major complication.

 

CONCLUSION

PAE in patients with BPH and AUR with bladder catheter is a safe procedure with successful removal of the bladder catheter and good short mid and long-term results.

 

31 – Setembro 14 – 18 CIRSE 2013

Cardiovascular International Radiological Society of Europe (CIRSE) Barcelona, participação da equipa médica do EAP do H.S. Louis

1 – Special session

Prostate artery embolization: real benefit or myth?

What do we know about outcomes of embolization in 2013?

J.M. Pisco ( Lisbon/PT)

When we start PAE we should have clear inclusion and exclusion criteria. After undergoing patient selection, those patients will have pelvic CT angiography (CTA) or pelvic magnetic resonance angiography (MRA) before PAE. This is because it is important to evaluate the pelvic vessels for tortuosity and atherosclerotic changes of the iliac and prostatic arteries’ anatomy.

A specific CT angiography protocol is applied and post-processing using maximum intensity projections (MIP) and volume rendering with 3D reconstructions are obtained. The anatomy and atherosclerotic involvement of the iliac and prostatic arteries, the degree of calcium and stenosis of prostatic origin could by this method be known in advance, before the procedure. CTA avoids catheterization of all other pelvic arteries and its use will ultimately reduce complications. Patients with advanced atherosclerosis of the iliac and prostatic arteries are excluded on the basis of Angio-CT.

With the help of Angio-CT, DSA and roadmaping, the prostatic arteries are catheterized with a coaxial micro-catheter. If there is only one prostatic artery, the micro-catheter should be placed before bifurcation in order to embolize both prostatic branches. The end point is the embolization of prostatic branches, with no reflux to other arteries and opacification of the gland. If there are two prostatic arteries on one side, one should start by the anterolateral or cranial branch as this irrigates the central part of the prostate. So if this branch is well embolized, we should not be worried about the caudal branch. Nevertheless, it is sometimes also embolized by collateral circulation through anastomosis.

Outcomes

In spite of the excellent results of UFE and its similarity to prostatic artery embolization (PAE), the first case of PAE was performed only in 2000 by DeMeritt in a patient with acute urinary retention and persistent haematuria. The patient stopped bleeding immediately after embolization, the patient’s voiding difficulties improved, the prostate volume reduced 40% and there was no sexual dysfunction. In March 2009, we performed the first PAE in a 76-yearold man on acute urinary retention and bladder catheter who refused surgery after two previous TURP. Five days later, the bladder catheter was successfully removed.

In 2010, Carnevale et al. reported the preliminary results in two patients with acute urinary retention due to BPH successfully treated by prostate artery embolization. One patient had bilateral PAE and the other unilateral PAE. Both patients could urinate spontaneously after removal of the bladder catheter 15 and 10 days after the procedure, respectively. At the 6 month follow-up, ultrasound (US) and magnetic resonance (MR) revealed a prostate reduction of 39.7% and 47.8%, respectively, for the bilateral PAE and 25.5% and 27.8%, for the patient submitted to unilateral PAE. The patient treated with bilateral embolization complained of retropubic pain for 24 hours treated with non-opioid analgesic. In 2011, Carnevale et al. reported the midterm follow-up after prostate embolization in the same two patients with BPH.

Results from Lisbon

At SIR 2010, we presented the preliminary results in the first 12 patients. The procedure was successful in 11 of the 12 patients (90.9%). The patients did not feel any pain during or after the procedure, except one. Four patients were in urinary retention before embolization. The vesical catheter was removed 5 days after the procedure in two patients and 10 days in the remaining ones. The symptoms improved in all the patients in whom the embolization was successfully performed (mean decrease in the IPSS of 8.2 points at 1 month and 9.3 points at 3 months). The mean prostate volume decreased from 96.3 to 74.3 cc (22.9%) at 1 month and an additional 9.95% at 3 months. The peak urinary flow rate increased 3.8 mL/sec at 1 month and an additional 1.5 mL/sec at 3 months. At the third month patients urinated without bladder catheter with a mean IPSS of 6.33 and a peak urinary flow rate of 9 mL/sec.

At SIR 2011 we presented the short and medium-term outcomes of PAE in BPH. PAE was technically successful in 66 of the 67 patients (98.5%) and the embolization was bilateral in 63 and unilateral in 3. In 62 patients with clinical success, at last follow-up, all the evaluated parameters had significant clinical improvement. The remaining 4 patients improved; however, the changes were not significant, and so are considered clinical failures. There was one case of a major complication, a 1.5 cm2 sized bladder wall ischaemia that was treated by surgical removal. Sixty-two patients were discharged 4-8 hours after the procedure, and the remaining ones were discharged the next morning.

More recent findings

At SIR 2012, Carnevale et al. presented 11 patients treated between June 2008 and November 2010. There was a technical failure (bilateral embolization) in 75% and clinical success in (10/11 patients) 91%. All patients were in acute urinary retention with bladder catheter. Patients urinated spontaneously between 4-25 days (mean 12.1) after catheter removal. Clinical overall improvement in LUTS at one year follow-up was observed by IPSS (mean 2.2) and QoL (mean 0.25). Minimum rectal bleeding (a teaspoon amount) was observed in 3/12 (25%) and focal bladder ischaemia is 1/12 (8.3%) procedures.

Recently we reported the short and medium term results of PAE in 89 patients. There were3 technical failures (3%). PAE was bilateral in 86 patients (92%) and unilateral in 7 patients (8%). At 1-month follow-up, IPSS decreased by 10 points. QoL score decreased by 2 points, peak urinary flow increased by 38%, prostate volume decreased by 20%, post-void residual volume decreased by 30 mL and IIEF score increased by 0.5 (all differences were significant, P<0.01). These changes were sustained throughout the observation period. Seventy-eight of the 86 patients (91%) were discharged from the hospital 6-8 hours after the procedure. The remaining eight patients were discharged the following morning, 18 hours after the procedure. 16 of the 86 patients (19%) had urinary tract infections after embolization that were treated with antibiotics, and there was transient haematuria in nine of the 86 patients (10%) and transient haemospermia that disappeared spontaneously without any treatment in six  (7%). Balanoprostatitis occurred in two of the 86 patients (2%) and inguinal haematoma in six (7%). Two patients had acute urinary retention after PAE, and a temporary bladder catheter was placed for a couple hours. One patient, already mentioned, developed bladder wall ischaemia.

Carnevale et al. recently published the results of PAE in 11 patients with BPH and indwelling urinary catheter. Ten out of eleven patients urinated spontaneously 4-25 days (mean 12.1 days) after vesical catheter removal. Post-embolization syndrome manifested as mild pain in the perineum, retropubic area and or urethra. In an asymptomatic patient, there was a hypoperfusion area of bladder suggesting small ischaemia of the bladder that was not detected at 90 days by MR follow-up. After one year the mean prostatic volume reduction was greater than 30%. There was symptoms improvement of IPSS (2.8 + 2) and Qol (0.4 + 0.5).

Procedure times

The procedure fluoroscopy time of the first 2 patients reported by Carnevale were 160/59 mins and 250/95 mins, respectively. Both patients were discharged 3 days after PAE. At CIRSE 2012, Carnevale reported an average of 2 hours for PAE. In our first reported 15 cases, the PAE procedure lasted between 25 and 135 minutes (mean 85 mins) and fluoroscopy time ranged between 15 and 45 minutes (mean 35 mins). All patients were treated as outpatients; 12 were discharged from the hospital 6-8 hours after the procedure and the remaining 3 patients 18 hours after, the next morning.

In our recent publication the PAE procedure lasted 25-185 minutes (mean 86 mins) and the fluoroscopy time was 7-63 minutes (mean 27 mins). 78 of the 86 patients (91%) were discharged from the hospital 6-8 hours after the procedure and the remaining 8 patients were discharged the following morning, 18 hours after PAE. The radiation dose of each patient ranges from 2.121 to 9.766 dGy cm23.050 dGy cm2 (mean).

Conclusion

In conclusion, it is very important to know the prostatic arteries anatomy through previous Angio-CT or Angio-MR in order to plan the procedure in advance and reduce the procedure and fluoroscopy time.

Today, more than 500 patients with BPH have been treated with PAE around the world with good and satisfactory results at both short and medium-term follow-up. In Europe, the United States and Brazil there are already several centres performing PAE. As of April 2013, we have treated over 400 patients with BPH, 17 of them with at least 3 years’ follow-up. Although we work with urologists, we have a lot of patients coming directly to us to be evaluated due to the results of the technique.

The data available in the literature are still limited and multicentric and more randomised studies are needed. With the results from two centres we can see a real benefit of PAE in selected patients with BPH.

References:

1. DeMeritt JS, Elmasri FF, Esposito MP, et al. Relief of benign prostatic hyperplasia-related bladder outlet obstruction after transarterial polyvinyl alcohol prostate embolization. J Vasc Interv Radiol 2000; 11(6): 767-770

2. Sun F, Sánchez FM, Crisóstomo V, et al. Benign Prostatic Hyperplasia: Transcatheter Arterial Embolization as Potential Treatment – Preliminary Study in Pigs. Radiology 2008; 246(3): 783-789

3. Jeon GS, Won JH, Lee BM, et al. The effect of transarterial prostate embolization in hormone-induced benign prostatic hyperplasia in dogs: a pilot study. J Vasc Interv Radiol 2009; 20(3): 384-390

4. Mauro MA. Can hyperplastic prostate follow uterine fibroids and be managed with transcatheter arterial embolization? Radiology 2008; 246(3): 657-658

5. Carnevale FC, Antunes AA, da Motta Leal Filho JM, et al. Prostatic artery embolization as a primary treatment for benign prostatic hyperplasia: preliminary results in two patients. Cardiovasc Intervent Radiol 2010; 33(2): 355-361

6. Carnevale FC, da Mota-Leal-Filho JM, Antunes AA, Baroni RH, Freire GC, Cerri LM, Marcelino AS, Cerri GG, Srougi M. Midterm Follow-up After Prostate Embolization in Two Patients with Benign Prostatic Hyperplasia. Cardiovasc Intervent Radiol 2011;34:1330-33

7. Carnevale FC, Mota Leal Filho J.M, Antunes A A et al Quality of life and symptoms relief support prostatic artery embolization for patients with acute urinary retention due to benign prostatic artery hyperplasia. J Vasc. Interventional Radiol Supplement 2012:23:35 Abstract 3

8. Carnevalle F, Motta Leal-Filho JM, Arturo AA et al,. Quality of life and clinical symptoms improvement support prostatic artery embolization for patients with acute urinary retention caused by benign prostatic hyperplasia JVIR 2013 Epub ahead of print.

9. Carnevale FC- Emboliztion for prostate gland hyperplasia: is there any evidence? Cirse 2012, Abstract 1105.3

10. Pisco J or, ;Martins JM. Correira M6, Internal Iliac Artery; Embolization to control Hemorrage from pelvic meoplasms. Radiology 1989; 172:337-339

11. Pisco JM, Pinheiro L, Bilhim T et al. Embolization of prostatic benign hyperplasia: preliminary results. J Vasc. Interventional Radiol. Supplement 2010; 21:25, Abstract 161

12. Pisco JM, Campos Pinheiro L, Bilhim T et al. Prostatic artery embolization to treat benign prostatic hyperplasia: short and medium term outcomes. J. Vasc. Intervent Radiol Supplement, 2011: Abstract 5

13. Pisco JM, Pinheiro LC, Bilhim T, et al. Prostatic arterial embolization to treat benign prostatic hyperplasia. J Vasc Interv Radiol 2011; 22(1): 11-9

14. Pisco JM, Pinheiro L, Bilhim T et al Further evaluation of prostatic artery embolization of symptomatic benign prostatic hyperplasia in a large series of patients. Safety, short and medium term outcomes JVIR suplement, 2012;23: 35, Abstract 78

15. Pisco J, Campos Pinheiro L, Bilhim T et al. Prostatic Arterial Embolization for Benign Prostatic Hyperplasia: Short and Intermediate term results: Radiology 2013; 266:5: 266-277

16. Bilhim T, Pisco JM, Furtado A._et_al, _ Prostatic arterial supply: demonstration by multirow detector Angio CT and Catheter Angiography. Eur_Radiol. 2011; 21:1119-26

17. Bilhim T, Pisco JM, Tinto HR et al: Prostatic arterial suplly: anatomic and imaging findings relevant for selective arterial embolization. JVIR 2012; 2012; 23:1403-1415

18. Delgal A, Cercuell JP, Kowtildis N. Outcome of Transcatheter arterial embolization for bladder and prostate hemorrhage. The journal of Urology 2010: 1835:1947-50

19. Nabi G, Sheikh N, Greene D et al. Therapeutic Transcatheter arterial embolization in the management of intractable hemorrhage from pelvic urological malignances: preliminary experience and longterm follow-up. BJU Int 2003; 92: 245-247

20. Rastinehad AR, Caplin DM, Gest MC et al. Selective arterial prostatic embolization (SAPE) for refractory hematuria of prostatic origin. Urology 2008: 71: 181-184

21. Mitchell ME, Waltman AC, Athanasoulis A et al. Control of massive prostatic bleeding with angiographic techniques. J Urol 1967: 115: 692-5

 

2 – Free paper session

Embolotherapy (excluding oncology)

1403.2 – Prostatic artery embolization for benign prostatic hyperplasia: preliminary results of a prospective randomized study comparing 200 µm and 200 + 300 µm PVA particles

H. Rio Tinto, T. Bilhim,, L Fernandes, J.A. Pereira, M. Duarte, L.C. Pinheiro, A.G. Oliveira, J.M. Pisco; Lisbon/PT.

Purpose – To evaluate and compare the preliminary results and clinical outcomes of prostatic artery embolization (PAE) for benign prostatic hyperplasia (BPH) using either 200 μm only vs 200 + 300 μm polyvinyl alcohol (PVA) particles.

Materials and Methods – This is a randomized prospective study with 80 BPH patients that underwent PAE. PAE was performed with only 200 µm PVA particles in 40 patients (Group I) and 200 µm + 300 µm particles in 40 patients (Group II). We evaluated the pain during and after the embolization. The follow-up is being assessed by measuring the IPSS, QoL, IIEF, prostate volume, PSA, Qmax and PVR measurements at 1 and 3 months.

Results – Preliminary results of this study show a mean pain scores during embolization: 1.6 (group I n=40); 1.0 (group II n=40); after embolization, mean pain scores: 0.1 (group I n=40) and 0 (group II n=40).

Mean IPSS/QoL reduction at 3 month follow-up: 5.2/1.4 (Group I n=16) and 8.9/2.0 (Group II n=19); mean prostate volume reduction: 33.3% (Group I n=13) and 5.5% (Group II n=16). Poor clinical outcome: 15.8% (Group I n=19) and 31.25% (Group II n=16). No significant differences in minor complication rates and no major complications were registered.

Conclusion – No significant differences were observed in pain severity or complication rates after PAE for BPH using either only 200 µm or 200 µm + 300 µm PVA particles. Although these are preliminary results, the clinical outcome at 3 months seems to be better with the use of 200 µm PVA particles.

1403.3 – Clinical outcome of prostatic arterial embolization for patients with symptomatic benign prostatic hyperplasia refractory to medical therapy:365 cases featured paper.

J.M. Pisco, L.C. Pinheiro, T. Bilhim, H. Rio Tinto, L. Fernandes, M. Duarte, J.A. Pereira, A.G. Oliveira; Lisbon/PT

Purpose – To evaluate the clinical outcome of Prostatic Artery Embolization (PAE) in 365 patients with Benign Prostatic Hyperplasia (BPH) and moderate to severe lower urinary tract symptoms (LUTS).

Materials and Methods – Single center cohort study in 365 consecutive patients with BPH and moderate to severe LUTS after failure of medical therapy for at least 6 months who underwent PAE. The age ranged between 45 and 89 years (mean 68, 7 ± 7.59 years  ) and the prostate volume between 40 to 269cc (mean 89cc ± 45.3cc). Seventy two patients had prostates larger than 100cc and 42 patients were in acute urinary retention with bladder catheter. International Prostate Symptom Score (IPSS), Quality of Life (Qol), International Index Erectile Function (IIEF), Quality of Life (Qmax), prostate volume (PV), Post-void residual volume (PVR) and Prostatic Specific Antigen (PSA) were evaluated before and at 1, 3, 6 and every 6 moths after the procedure, in order to access the clinical outcome. The follow up control ranged from 3 to 42 months (mean 14 months  ). As embolic material, non-spherical PVA – 100µm and 200µm particles were used. Clinical success was considered as symptoms improvement (IPSS reduction at least 25% of the total score and lower than 15 points), quality of life improvement (reduction of Qol at least 1 point and or equal or lower to 3 points) and no need of medical therapy or any other treatment after PAE.

Results – All patients were treated as outpatients. Thirteen patients were lost to follow up. From the 352 controlled patients there were 86 (24.4%) clinical failures, 54 (15, 3%) at short term and 32 (9.1%) at mid term. The best results were shown in patients with prostate larger than 100cc and very severe symptoms (IPSS >25). PAE was repeated in 12 patients with clinical failure and there was clinical success in 8. From the other patients with clinical failure, 8 were treated by TURP, 3 had open prostatectomy and the remaining are under medical therapy. Cumulative rates of clinical success at short term were at 3 months 84.9%, at 6 months 80.5%, at 12 months 77.2%, at medium term at 18 months 76.9%, at 24 months, 30 months, 36 months and at 42 months 74.3%. Mean IPSS/QoL reduction was 10.9/2.8 and mean PV reduction was 16.2%. The IIEF increased in 114 patients (32.4%). As a major complication there was just a bladder wall ischemia treated by simple surgery and some minor complications.

Conclusion – PAE is a safe, outpatient procedure for patients with BPH and moderate to severe LUTS,refractory to medical therapy. with good short and mid-term results, particularly in patients with prostate larger than 100cc and very severe symptoms.

 

3 – Posters

P-112 – How to improve the clinical results of prostatic artery embolization (PAE) for patients with benign prostatic hyperplasia (BPH) and moderate to severe lower urinary tract symptoms (LUTS)

J.M.Pisco, L.C. Pinheiro, T. Bilhim, H. Rio Tinto, L. Fernandes, J.A Pereira, M. Duarte, A.G. Oliveira; Lisbon/PT

Purpose- To investigate the main causes of clinical failure in order to avoid them and to improve the clinical success of Prostatic Artery Embolization (PAE).

Material and Methods- Retrospective study in 365 patients with BPH and moderate to severe lower urinary tract symptoms (LUTS) who underwent PAE. The follow up control ranged between 3 and 46 months (mean 14 months). Clinical success was considered when there was clinical improvement with International Prostate Symptom Score (IPSS) reduction ≥ 25% of the total score and ≤ 15, Quality of life (Qol) reduction ≥ 1 or ≤ 3 and no need of medical treatment or any other treatement.

Results- There were 86 (24.4%)  clinical failures, 54 (15.3 %) at short term and 32 (9.1%) at mid term. The main causes of clinical failure were: unilateral embolization (29 patients), incomplete embolization (19 patients), small size particles of 100 µm as embolic agent (18 patients) and unknown cause (20 patient). The patients with incomplete or unilateral embolization had advanced atherosclerosis of the iliac and prostatic arteries and 16 of them had difficult prostatic artery anatomy. Twelve of the patients had diabetes and 11 were heavy smokers. Ten of the patients with clinical failure without any cause were under treatment with 5 œ reductase  inhibitors. There was a major complication – a bladder wall ischemia.

Conclusion- To improve the clinical results of PAE, patients with advanced atherosclerosis of the iliac and prostatic arteries particularly those with difficult prostatic artery anatomy should be informed of the high failure rate and PAE can eventually be cancelled. The same information should be given to those under 5 œ reductase inlibitors; 100 µm particles should not be used as embolic agent.

P-113 – Embolization in patients with benign prostatic hyperplasia and refractory acute urinary retention

L. Fernandes, J.M. Pisco, L.C. Pinheiro, H. Rio Tinto, T.Bilhim, M. Duarte, J.A. Pereira, A.G. Oliveira; Lisbon/PT

Purpose – To evaluate the clinical outcome of prostatic arterial embolisation (PAE) in patients with benign prostatic hyperplasia (BPH) and acute urinary retention.

Materials and Methods – Single center cohort study in 42 patients with a diagnosis of BPH and acute urinary retention. The patients underwent prostatic arterial embolization (PAE). Prostate volume and Prostatic Specific Antigen (PSA) were evaluated before PAE. Non-spherical Polyvinyl Alcohol Particles (PVA) 100µm and 200µm were used for embolisation. The International Prostate Symptom Score (IPSS), Quality of Life (QoL), International Index Erectile Function (IIEF), uroflowmetry, (Qmax and PVR – post voiding residual volume), Prostatic Specific Antigen (PSA) and prostate volume were assessed at 1, 3, 6 and every 6 months after removal of the bladder catheter, up to 36 months (mean 14.4 months).

Results – forty-two patients aged 48 – 81 years (mean 67.2±8.1 years) were included in this study. The prostate volume ranged between 50 and 220 cc (mean 105.3±37.2 cc). PAE was technically possible in 41 of 42 patients (97.6%). All patients were treated as outpatients. Among the 40 patients with efficacy data there were 6 (15.0%) clinical failures. Kaplan-Meier estimates of the cumulative rate of clinical success rate were as follows: 95.0% (95% confidence interval (CI) 81.5% – 98.7% at 3, 6 and 12 months, 75.1% (95% CI 50.2% – 88.8%) at 18, 30 and 36 months. There were no major complications and no sexual dysfunction.

Conclusions – PAE is a minimally invasive procedure with good short and medium term results, for BPH patients with acute urinary retention and may be an alternative to surgery.

P-114 – Embolization for patients with benign prostatic hyperplasia, very large prostate, and moderate to severe lower urinary tract symptoms (LUTS) as an alternative to open surgery

J.M. Pisco, L. C. Pinheiro, T. Bilhim, H. Rio Tinto, M. Duarte, L. Fernandes, J.A. Pereira, A.G. Oliveira; Lisbon/PT

Purpose – To access outcome of prostatic arterial embolization (PAE) for patients with benign prostatic hyperplasia (BPH), prostate larger than 100 and moderate to severe lower urinary tract symptoms (LUTS), after failure of medical therapy for at least 6 months.

Materials and Methods – Single center cohort study in 72 patients (aged 48 – 80 years, mean age 67.6 ± 6.7 years) with a diagnosis of BPH, large prostate larger than 100cc and moderate to severe LUTS after failure of medical treatment for at least 6 months, underwent PAE.Twenty patients were in urinary retention and bladder catheter. Non-spherical Polyvinyl Alcohol Particles (PVA) were used for embolization. The prostate volume ranged between 100 and 269 cc (mean 129.5 ± 32.3 cc). The International Prostate Symptom Score (IPSS), Quality of Life (QoL), International Index Erectile Function (IIEF), uroflowmetry, (Qmax – peak urinary flow and PVR – post voiding residual volume), Prostatic Specific Antigen (PSA) and prostate volume, were assessed before PAE, at 1, 3, 6 and every 6 months thereafter. Patients were evaluated up to 36 months (mean 12.3 months).

Results – PAE was technically successful in 71 of 72 patients (98.6%). Follow up data was available for 67 patients. Four patients were lost to follow up. From the total 67 controlled patients there were 16 (23.9%) clinical failures, 9 at short term and 7 at medium term. Cumulative rates of clinical success at short term were at 3 months 81.4%, at 6 months 78.5%, at 12 months 69.8%, and at medium term at 18 months 69.8%, at 24 months 69.8 % and at 30 months 55.9%.There was low morbidity, no major complication and no sexual dysfunction in this group of patients.

Conclusions – PAE is a minimally invasive procedure with good and satisfactory short and medium term results, respectively, for BPH patients with prostate larger than 100cc and moderate to severe after failure of medical therapy, as an alternative to open surgery.

P – 119 – Preliminary results of prostatic artery embolization in patients with symptomatic benign prostatic hyperplasia and small prostate volume (40cc)

J.A. Pereira, L. Fernandes, H. Rio Tinto, T.Bilhim, M. Duarte, J.M. Pisco; Lisbon/PT

Purpose:

To analyze the individual baseline parameters and the outcome of prostatic artery embolization (PAE) in patients with symptomatic benign prostatic hyperplasia (BPH) and small prostate volume (<40cc).

Materials and methods:

Twelve patients (age range 47-82, mean age 62 years) with symptomatic BPH and small prostate volume (<40cc) underwent PAE for symptomatic relief.

Baseline values included a prostate volume range from 24 to 40 (mean 35,6) mL, an International Prostate Symptom Score (IPSS) between 17 and 31 (mean 25,8) points, QoL between 4 and 5 (mean 4,4) points, PSA between 0,37 and 8,24 (mean 2,17) ng/dL, Post-Void-Residual Urine (PVR) between 12 and 85,5 (mean 54,1) mL, Peak flow-rate (Qmax) between 3-18,3 (mean 9,6) mL/s, International Index of Erectile Function (IIEF) between 4 and 30 (mean 20,4) points.

Non-spherical PVA particles (100μm and/or 200μm) were used as embolizing agent.

Control follow-up was made between 1 to 18months (mean 10,6 months) after the procedure.

Results:

Embolization was bilateral in 11 patients and unilateral in 1 patient. At the last follow-up control there was clinical improvement in 8 of the 12 patients. In this group there was a mean IPSS reduction of 26,8 to 13,1 (-51,1%) points, a mean QoL reduction of 4,5 to 2,1 ( 53,4%) points and a mean prostate volume reduction of 33,9 to 28 ( 17,4%) mL.

Conclusion:

In patients with symptomatic BPH and small prostate volumes, PAE is a procedure with good short and mid-term clinical results.

P – 121 – Prostatic artery embolization with Embozene for symptomatic patients with benign prostatic hyperplasia: preliminary results

H. Rio Tinto, L. Fernandes, T. Bilhim, L.C. Pinheiro, J.A. Pereira, M. Duarte, J.M. Pisco; Lisbon/PT

Purpose

To access the preliminary results of prostatic arterial embolization (PAE) with Embozene for symptomatic patients with benign prostatic hyperplasia (BPH).

Material and Methods

Six patients (aged 59 – 67 years), with a diagnosis of BPH, after failure of medical treatment for at least 6 months, underwent PAE with Embozene. Embozene 250µm were used for embolization in 4 patients and Embozene 400µm in 2 patients. The International Prostate Symptom Score (IPSS), Quality of Life (QoL), International Index Erectile Function (IIEF), uroflowmetry, (Qmax – peak urinary flow and PVR – post voiding residual volume), Prostatic Specific Antigen (PSA) and prostate volume, were assessed before PAE and at 1 and 3 months after.
Clinical success was considered as symptoms improvement (IPSS reduction at least 25% of the total score and lower than 15 points), quality of life improvement (reduction of Qol at least 1 point and or equal or lower to 3 points) and no need of medical therapy or any other treatment after PAE.

Results

All patients were treated as outpatient and were released from the hospital 3 to 6 hours after the procedure. There were no complications. There was one clinical failure which embolization was performed with Embozene 400µm. Clinical success was shown in 5 patients who stop all prostatic medication.

Conclusion

PAE with Embozene is a safe and minimally invasive procedure with good short term results.

P – 129 – Management of difficult prostatic artery embolization cases

L. Fernandes, H. Rio Tinto, J.A. Pereira, T. Bilhim, M. Duarte, J.M. Pisco; Lisbon/PT

Learning objectives:

To describe  the importance of understanding some peculiar anatomical variants in prostatic arterial supply using angio- CT (CTA) and digital subtraction angiography (DSA) to perform selective prostatic artery embolization successfully.

Background

Prostatic arterial embolization (PAE) gained special attention in the past years as a potential minimally invasive technique for benign prostatic hyperplasia (BPH).

Prostatic artery supply has some complex anatomic variations.

CTA evaluation before PAE allows characterization of the number of prostatic arteries, their origin, trajectory, termination and anastomoses with surrounding arteries.

Clinical Findings/ Procedure

On the basis of CTA pelvic anatomy, it’s possible to anticipate limitations and difficulties of the procedure. Correct and safe performance of PAE is very important in order to optimize clinical results.

If the arterial anatomy on the basis of the CTA is not suitable (tortuosity of iliac and/or prostatic arteries) or if there are extensive atherosclerotic changes, the procedure is not performed.

Conclusion

Planning PAE in advance is advisable before entering the Angio Suite on the basis of CTA pelvic anatomy findings, to choose the best approach, the catheters to be used and possible limitations or difficulties of the procedure to be truly successful.

P – 130 – Prostatic artery embolization – important anastomoses and learning when to stop

L. Fernandes, H. Rio Tinto, J.A. Pereira, T. Bilhim, M. Duarte, J.M. Pisco; Lisbon/PT (poster Award)

Learning objectives:

To review important prostatic artery anastomoses with surrounding arteries, using angio- CT (CTA) and digital subtraction angiography (DSA), and their importance to perform selective prostatic artery embolization safely, and learn when to stop.

Background

Prostatic arterial embolization (PAE) is a minimally invasive technique for benign prostatic hyperplasia (BPH).

Age-related vasculopathy has been suggested as the etiology for BPH. This theory suggests

That there is an association of BPH with lower urinary symptoms with erectile dysfunction and chronic pelvic pain syndrome and that BPH is a manifestation of an aging vascular disease rather than as etiopathogenic factor.

Clinical Findings/ Procedure

Prostatic artery supply has some complex anatomic anastomosis to other vessels, CTA evaluation before PAE and DSA allows characterization of the number of prostatic arteries, their origin, trajectory, termination and anastomoses with surrounding arteries.

It is important to recognize when the anastomoses have high flow to avoid unnecessary complications.

If there is such risk, try to avoid particles migration to that vessels, and if it is not possible, the correct option is not to embolize.

Conclusion

Recognize the type of the prostatic artery anastomoses with the surrounding vessels, plays a crucial role to correct and safe performance of PAE, and is very important in order to optimize clinical results.

4 – Workshop

Prostate artery embolization: how i do it

706.1 J.M. Pisco (Lisbon/PT)

5 – Sinposio

Tecnicas para la embolización de prostata

J.M. Pisco (Lisbon/PT)

Prostate embolization for BHP: anatomical and technical considerations

T. Bilhim (Lisbon/PT)

 

30 – Asan International Medical Symposium 2013, Seoul, Junho 22 como convidado MP proferiu uma conferencia “Prostatic Arterial Embolization (PAE) for Symptomatic Patients with Benign Prostatic Hyperplasia

foto1

29- Embolization of prostatic benign hyperplasia. Preliminary results

João M. Pisco, Luís Campos Pinheiro, Tiago Bilhim, Marisa Duarte, Jorge Rocha Mendes
SIR Abstract Book Pag. S63 – March 14, 2010

1 – University Department of Radiology, 2 – University Department of Urology, 3 – University Department of Anatomy, Faculty of Medical Science, New University of Lisbon, Hospital Saint Louis, 4 – Department of Urology of Curry Cabral Hospital

Purpose – To evaluate the efficacy, morbidity and outcomes of prostatic artery embolization in patients with symptomatic benign prostatic hyperplasia (BPH).

Material and methods – Embolization was performed in 12 patients with symptomatic BPH, (mean international prostatic symptom score – IPSS of 21, ages between 70 and 78 years (mean 74). One patient had a transrectal resection of prostate (TURP) 14 years before and 4 patients had bladder catheters (urinary retention).

Magnetic resonance, transrectal pelvic ultrasound, fluxometry and PSA were performed in each patient before embolization and the last 3 exams, at 1 and 3 months after embolization. The mean prostatic volume before embolization was 96.3 c.c. Questionnaires were filled by the patients before, at 1 and 3 months after the procedure. The patients stopped all prostatic medication one week before embolization and started an anti-inflammatory drug (naproxeno, 500 mg by mouth, twice a day) 2 days before the procedure and continued for 5 days following the embolization.

During embolization analgesic and anti-inflammatory drugs were given intravenously. Embolization was performed under local anesthesia. For the purpose a C2F5 catheter was introduced in right femoral artery. The Waltman loop was performed to catheterize the hypogastric artery and micro-catheter was used for superselective catheterization. The catheter was placed in the anterior division of the hypogastric artery and then in the inferior vesical artery and at last in the prostatic vessels. For embolization polyvinyl alcohol (PVA) particles 200 µ were used.

Results – The procedure was successful in 11 of the 12 patients (90.9%). In one patient, the prostatic arteries were impossible to catheterize due to tortuosity and atherosclerotic changes. The patients did not feel any pain during or after the procedure, except one. The vesical catheter was removed 5 days after the procedure in 2 patients and 10 days in the remaining patients. The symptoms improved in all the 11 patients in whom the embolization was successfully performed (mean decrease in the IPSS of 8.2 points at 1 month and 9.3 points at 3 months). The mean prostate volume decreased from 96.3 to 74.3 cc (22.9%) at 1 month and 9.95% at 3 months. The mean post void residual volume of 7 patients who were without vesical catheter decreased from 187 to 98 (47.6%) at 1 months and 52.4% at 3 months.

The peak urinary flow rate increased 3.8 ml/sec at 1month and 1.5 ml/sec at 3 months. 4 patients were in urinary retention before embolization. At month 3 all of them urinate without bladder catheter with a mean IPSS of 6.33 and Qmax of 9 ml/sec. There were 2 urinary infections after embolization in 2 patients and no other complications were recorded.

Conclusion – Embolization of the prostatic arteries in patients with symptomatic BPH is a feasible procedure with low morbidity and good outcomes at 1 and 3 months.

3 – HPB

A hiperplasia  benigna da próstata (HBP) tem elevada prevalência nos homens com idades entre os 50 e 79 anos sendo frequentemente sintomática. Há uma necessidade de novas formas terapêuticas para melhorar os resultados e minimizar a morbilidade.

João M. Pisco, Luís Campos Pinheiro, Tiago Bilhim, Marisa Duarte, Jorge Rocha Mendes

Pretendeu-se com este estudo avaliar a fasibilidade, morbilidade e resultados da embolização das artérias prostáticas (EAP) no tratamento da HBP.

Quinze doentes (62-82 anos, média 74.1) com HBP sintomática optaram por serem tratados por EAP com partículas de polivinil álcool 200µm, após falência da terapêutica médica. O procedimento foi efectuado por abordagem femoral unilateral com anestesia local.

O procedimento  foi fazível em 93.3% dos doentes (1 doente excluído por extensas alterações ateromatosas que impossibilitaram a cateterização prostática selectiva). O follow-up médio foi de 6.5 meses (3-11meses). O IPSS (internacional prostate symptom score) reduziu 9.4 pontos, a qualidade de vida melhorou 0.9 pontos, o IIEF ( international index of erectile function) melhorou 1.7 pontos e o pico de fluxo urinário melhorou 4.4 pontos. O PSA  reduziu em média 26.1% e o volume prostático 27.2%.
Houve uma complicação major com necrose parcial da bexiga.

A EAP é um procedimento fazível, com baixa morbilidade, sem disfunção sexual e com bom controlo sintomático nos doentes com HBP.

28 – Male internal iliac and prostatic artery anatomy – imaging findings

Tiago Bilhim, João Martins Pisco, Marisa Duarte, Hugo Rio Tinto, João O’Neill.
CIRSE 2010 – Abstractbook – Poster – Pag 413; P-312 Outubro 2-6 Valença – Espanha


27 – Prostatic arterial embolization to treat benign prostatic hyperplasia

J.M.Pisco, L.C.Pinheiro, T. Bilhim, J.R.Mendes
CIRSE 2010 – Abstractbook – Free Paper – Pag 319; 1209.3 Outubro 2-6 Valença – Espanha


26 – Male Pelvic Vascular Anatomy and Prostatic Artery Anatomy

(Poster – RSNA, 2010)

Tiago Bilhim; João M. Pisco; Sandra M. Duarte; Hugo A. Rio Tinto; João O’Neill

1.To review the basic branching patterns of the male pelvic vascular anatomy; 2.To review the origin and anatomical characteristics of the prostatic arteries (PA); 3.To compare the diagnostic performances of angio-MR, angio-CT and angiography; 4.To describe the main anatomical patterns and variations of the Internal Iliac Artery (IIA) and PA.

CONTENT ORGANIZATION
• Major basic branching patterns of male IIA – Adachi/Yamaki’s classification
• Major IIA branches – Superior gluteal, Inferior gluteal, Internal pudendal arteries
• Other dominant vessels – obturator and PA arteries
• PA origin and anatomical findings
• Review of imaging findings – vascular male pelvis
16-slice angio-CT
1.5T Angio-MR
Angiography
• Sample cases and mimics

SUMMARY
The PA usually originates from the pudendal artery, with origins from the obturator or superior vesical arteries being less frequent; 2.The PA has some consistent anatomical findings with a characteristic ‘corkscrew’ pattern and terminating in the inferior vesical and intra-prostatic branches; 3.Angiography and 16-slice angio-CT show similar diagnostic performances in identifying the pelvic vascular branching patterns and the PA anatomy. Angio-MR failed to detect small vascular branches.

25 – Tips and Tricks on Prostatic Arterial Embolization

(Poster – RSNA, 2010)

Tiago Bilhim, João Pisco, Luis Pinheiro, Hugo Rio Tinto, Sandra Duarte, Jorge Mendes
Prémio – Certificado de Mérito.

PURPOSE/AIM
1. To review the clinical findings and evaluation of benign prostatic hyperplasia (BPH); 2. To review the main clinical parameters of disease severity; 3. To discuss the pre-embolization work-up; 4. Tips and tricks on how to perform prostatic arterial embolization (PAE); 5. How to perform the follow-up.
CONTENT ORGANIZATION
• Clinical evaluation of disease severity
– International Prostate Symptom Score – IPSS;
– Quality of life score – Qol;
– International index of erectile function – IIEF;
– Uroflowmetry – peak urinary flow – Qmax; Post-void residual volume – PVR.

• Pre-embolization Assessment – Clinical data; Prostatic ultrasound; Pelvic Angio MR and Angio CT
• PAE – tips and tricks
• Clinical and Imaging Follow-up
– IPSS; Qol; IIEF
– PSA
– Qmax; PVR
– Prostatic ultrasound and MR

SUMMARY
1. IPSS and Qol are validated questionnaires that evaluate BPH symptom severity; 2. It is important to assess the male sexual function before and after PAE because BPH and many treatment options are associated with sexual dysfunction; 3. Uroflowmetry parameters are essential in evaluating response to treatment; 4. PSA and prostate imaging help exclude possible cancer and evaluate prostatic volume before and after PAE; 4. Pelvic angio MR and angio CT give us detailed anatomy before intervention.

24 – Embolization of Prostatic Benign Hyperplasia. Short Term Results

(Comunicação Oral, como Abstracto distinto – RSNA, dezembro 2, 2010)

João Pisco, Luis Pinheiro, Tiago Bilhim, Sandra Duarte, Jorge Mendes

PURPOSE
To evaluate whether prostatic arterial embolization (PAE) is a feasible and effective procedure, without sexual dysfunction, in patients with symptomatic benign prostatic hyperplasia (BPH) and to show the short term results.

METHOD AND MATERIALS
Twenty four patients, aged 62 – 82 years (mean 74.6 years) with symptomatic BPH, after failure of medical treatment were selected for PAE. Nine patients were in urinary retention with bladder catheters. The patients stopped all prostatic medication one week before PAE and started an anti-inflammatory 2 days before and continued for 5 days following the embolization. The following parameters were evaluated before, 1, 3, 6 and 12 months after PAE: IPSS – international prostate symptom score; QoL – quality of life IIEF – international index of erectile function; PSA – prostate specific antigen; Qmax – peak urinary flow; prostate volume by transrectal ultrasound, and magnetic resonance, and PVR – post-void residual volume. PAE was performed under local anaesthesia, by single femoral approach with a C2F5 catheter and a microcatheter. Non spherical 200 μm polyvinyl alcohol (PVA) particles were used. Twenty one patients were discharged 6 – 8 hours after the procedure and three 18 hours later, the next morning.

RESULTS
PAE was technically successful in 23 of the 24 patients (95.8%). Only one patient referred pain during the procedure. The control follow-up was performed at 1 and 3 months in all patients, at 6 months in 8 patients and at 12 months in 10 patients. There was a mean follow up of 7.9 months (range 3 – 12 months). The vesical catheter was removed 5 days after the PAE in 3 patients and 10 days in the remaining 6 patients. The symptoms improved in all the 23 patients in whom the embolization was successfully performed, however 5 of them were considered failures due to slight improvement (21.7%). At last follow up, the IPSS decreased 9.8, the Qol decreased 1.3 the IIEF increased 1.1, the PSA decreased 27.2%, the Qmax increased 5.2ml, the prostate volume decreased 28.5% and the PVR decreased 68%. There were 2 urinary infections. There was a major complication due to 1.5 cm square sized of bladder wall ischemia treated by surgical removal.

CONCLUSION
PAE is a feasible and effective procedure in patients with symptomatic BPH, with good short term results and without sexual dysfunction.

CLINICAL RELEVANCE/APPLICATION
This is the first report to date of PAE in the treatment of BPH

 

23 – Prostatic Arterial Embolization to Treat Benign Prostatic Hiperplasia – Short and Medium Term Outcomes. Distinguished Abstract.

Pisco JM,  Pinheiro LC, Bilhim T, Santos VV, O’Neill JE.

SIR 2011, March 28, Washington DC

 

22 – Prostatic artery embolization to treat benign prostatic hyperplasia – short and medium term outcomes

European Association of Urology

Campos Pinheiro, L.1, Pisco, J.2, Bilhim, T.2, Vaz Santos, V.1, O’Neill, J.3

Abstract of European Association of Urology

Centro Hospitalar Lisboa Central, Dept. of Urology, Lisbon, Portugal, Hospital S Luis, Dept. of Radiology, Lisbon, Portugal, Faculdade Ciencias Médicas, Dept. of Anatomy,
Lisbon, Portugal

Introduction & Objectives

The purpose is to evaluate the short and medium term results of prostatic artery embolization (PAE) in patients with symptomatic benign prostatic hyperplasia (BPH) with Polyvinyl Alcohol (PVA) particles 100 mm or 200 mm.

Material & Methods

Prostatic artery embolization (PAE) was indicated in 57 patients with symptomatic BPH, after failure of medical treatment; age ranged between 60 and 82 years (mean 72.6 years). Twelve patients had urinary retention with bladder catheter. Prostate volumePSA, uroflowmetry (peak urinary flow and PVR – post voiding residual volume), IPSS (International Prostate Symptom Score), IIEF (International Index Erectile Function) were evaluated before PAE and 1, 3, 6 and every 6 months thereafter. The mean prostate volume before PAE was 94.6cc. The procedure was performed under local anaesthesia by a single femoral approach with a C2F5 and a micro catheter. Analgesic and antiinflammatory drugs were given before, during and after PAE. Pelvic Angio MR was performed before PAE and 200 mm non-spherical PVA particles were used in the first 14 patients. In the last 42 patients Pelvic Angio CT was performed before PAE and 100 mm PVA particles were used. The control follow-up was performed between 1 and 18 months (mean 8.6 months) after PAE.

Results

PAE was technically successful in 56 of the 57 patients (96.4%) and in 3 patients the embolization could be performed only unilaterally. With Pelvic Angio MR and Pelvic Angio CT the common, external and internal iliac arteries could be visualized. The prostate arteries could be shown only by pelvic Angio CT. There were 4 clinical failures (7.1%). In the remaining 52 patients with clinical success, at last follow-up, the mean prostate volume decreased 28.1%, the IPSS decreased 9.8 points, the QoL improved 1.9 points, the IIEF increased 1.8 points and the peak urinary flow increased 6.1 and the PSA decreased 26.1%. There was no deterioration of the sexual function in any patient. Better results were obtained with 100 mm PVA particles than with 200 mm PVA particles. As complications there was one case of bladder wall ischemia that was treated by surgical removal, 3 cases of transient urinary retention treated with bladder catheter for 5 days, 6 cases of urinary infection treated with antibiotics and 2 cases of inguinal haematoma. Six patients referred pain during the procedure. One had severe pain, and the remaining 5 patients slight to moderate pain. Fifty-two patients were treated as outpatients and were discharged 4 – 8 hours after the procedure and four were discharged the next morning (18hours later).

Conclusions

PAE in patients with symptomatic PBH is safe, with low morbidity, good short and medium term results that are better with 100 mm PVA particles.

21 – Prostatic Artery Embolization to Treat Benign Prostatic Hyperplasia – Short and Medium Term Outcomes

The Journal of Urology, Vol.185, No. 4S, 2011

Luis Campos Pinheiro, João Pisco, Tiago Bilhim, Vitor Vaz Santos, João O’Neill, Lisbon, Portugal

INTRODUCTION AND OBJECTIVES: Evaluate the short and medium term results of prostatic artery embolization (PAE) in patients with symptomatic benign prostatic hyperplasia (BPH) with Polivinyl Alcohol (PVA) particles 100 µm or 200 µm.

METHODS: Prostatic artery embolization (PAE) was indicated in 57 patients with symptomatic BPH, after failure of medical treatment; age ranged between 60 and 82 years (mean 72.6 years). Twelve patients had urinary retention with bladder catheter.

Prostate volume, PSA, Uroflowmetry, IPSS, IIEF were evaluated before PAE and 1,3,6 and every 6 months thereafter. The mean prostate volume before PAE was 94.6 cc. The procedure was performed under local anaesthesia by a single femoral approach with a C2F5 and a micro catheter. Analgesic and anti-inflammatory drugs were given before, during and after PAE. Pelvic Angio MR was performed before PAE and 200 µm nonspherical PVA particles were used in the first 14 patients. In the last 42 patients Pelvic Angio CT was performed before PAE and 100 µm PVA particles were used. The control follow-up was performed between 1 and 18 months (mean 8.6 months) after PAE.

RESULTS: PAE was technically successful in 56 of the 57 patients (96.4%) and in 3 patients the embolization could be performed only unilaterally. With Pelvic Angio MR and Pelvic Angio CT the common, external and internal iliac arteries could be visualized. The prostate arteries could be shown only by pelvic Angio Ct.

There were 4 clinical failures (7.1%). In the remaing 52 patients with clinical success, at last follow-up, the mean prostate volume decreased 28.1%, the IPSS decreased 9.8 points, the QoL improved 1.9 points, the IIEF increased 1.8 points and the peak urinary flow increased 6.1 and the PSA decreased 26.1%. There was no deterioration of the sexual function in any patient. Better results were obtained with 100 µm PVA particles than with 200 µm PVA particles.

As complications there was one case of bladder wall ischaemia that was treated by surgical removal, 3 cases of transient urinary retention treated with bladder catheter for 5 days, 6 cases of urinary infection treated with antibiotics and 2 cases of inguinal haematoma.

Six patients referred pain during the procedure. One had severe pain, and the remaining 5 patients slight to moderate pain.

Fifty-two patients were treated as outpatients and were discharged 4-8 hours after the procedure and four were discharged the next morning (18 hours later).

CONCLUSIONS: PAE in patients with symptomatic PBH is safe, with low morbidity, good short and medium term results that are better with 100 µm PVA particles.

20 – Abstratos de poster apresentado no CIRSE 2011

Prostatic arterial supply: anatomical and imaging findings

Accessory pudendal arteries: what is in the name? Relevance for prostatic arterial embolization
T. Bilhim, J.M.Pisco, L.C.Pinheiro, H.A.M. Rio Tinto, M.Duarte, J.O’neill

19 – Comunicação livre, apresentada como distinta no CIRSE 2011

J.M.Pisco, L.C.Pinheiro, T.Bilhim, H.A.M. Rio Tinto, V.V. Santos, A.G.Oliveira, J.O’neill

 

 

 

18 – Abstracto apresentado RSNA – 28 Novembro 2011

Embolization of Benign Prostatic Hyperplasia in Symptomatic Patients. Short and Medium Term Results

1João M. Pisco, 2,5Luís Campos Pinheiro, 3Tiago Bilhim, 4Hugo Rio Tinto, 5Vitor Vaz Santos, 3João O’Neill 
JVIR 2011; 22:11-19

1 – University Department of Radiology, 2 – University Department of Urology, 3 – University Department of Anatomy, Faculty of Medical Science, New University of Lisbon, Hospital Saint Louis, 4 – Department of Radiology S. José Hospital, 5 – Department of Urology of S. José Hospital

Purpose – To evaluate the morbidity and the short and medium term results of prostatic arterial embolization (PAE) in patients with symptomatic benign prostatic hyperplasia (BPH).

Methods – Ninety-two patients, aged 52 – 82 years (mean 69.5 years) with symptomatic BPH, after failure of medical treatment for at least 6 months, were selected for PAE.

The patients were evaluated before, 1, 3, 6, 12 and every 6 months after PAE.

Non spherical 200 mm and 100 mm polyvinyl alcohol (PVA) particles were used. Eighty-seven patients were discharged 2 – 8 hours after the procedure and five 18 hours later, the next morning.

Results – PAE was technically successful in 89 of the 92 patients (96.7%). In 8 patients, only one side prostatic artery was embolized. Only 9 patients referred light to moderate pain, and there was one major complication, a bladder ischemia.

At 3 months the symptoms improved significantly in 73 patients (82%). Sixteen of them were considered failures due to slight improvement in 15 (18%) or no improvement in one patient (0.1%). From the 15 patients controlled at 18 months there was improvement in 12 (80%) and recurrences in 3 (20%).     

Conclusion – PAE is a safe and effective procedure, in patients with symptomatic BPH, with good short and medium term results.  

17- Abstracto apresentado SIR – Março 2012

Further Evaluation of Prostatic Artery Embolization for Patients with Benign Prostatic Hyperplasia Short and Medium Term Results

João M. Pisco, Luís Campos Pinheiro, Tiago Bilhim, Hugo Rio Tinto, Lúcia Fernandes, Marisa Duarte, José Pereira and A. Gouveia Oliveira

St. Louis Hospital and University Department of Radiology, Faculty of Medical Sciences, New University of Lisbon

Purpose – Evaluate the safety and short and medium term results of prostatic artery embolization (PAE), in patients with benign prostatic hyperplasia (BPH) and very prostate, larger than 100cc.

Material and Methods – Fifty four patients with symptomatic BPH, and prostate larger than 100cc were treated by PAE. Age ranged between 48 and 85 years (mean 73.9 years). Before PAE the prostate volume ranged between 100cc and 270cc (mean 142.7), the IPSS (Interventional prostate symptom score) between 17 and 35 (mean 4.7) and the QoL (Quality of life) between 3 and 6 (mean 4.7). Nonspherical PVA particles 100µm or 200µm were used. These parameters were evaluated at 1, 3, 6 months and every 6 months after the procedure. The control follow-up was performed between 1 and 36 months (mean 14.3 months) after PAE.

Results – PAE was technically successful in 53 of the 54 patients (98.1%) and the embolization was bilateral in 48 patients (90.6%) and unilateral in 5 patients (9.4%). At last follow up control there was clinical improvement in 41 of the 53 patients (77.4%). In these patients the mean prostate volume reduced from 142.7cc to 97.6cc (31.6%), the IPSS reduced from 22.8 to 11.7 (48.7%) and the QoL from 4.7 to 2.8 (40.4%). In this group of patients there was not any major complication.

Conclusion – PAE in patients with symptomatic BPH and very large prostate, larger than 100cc, is a safe procedure with low morbidity and good results at short and medium term.

16 – Abstracto da Conferência proferida no XIV Congresso Asiático em Kobe, Japão, como orador convidado.

15 – Comunicações Livres  CIRSE 2012

Oral Scientific Presentation – Featured paper – 1402.3 Prostatic arterial embolization: criteria to predict treatment outcome. T. Bilhim, J.M. Pisco, H. Rio Tinto, L. Fernandes, J.A. Pereira, M. Duarte, L.C. Pinheiro, A.G. Oliveira, J. O’Neill; Lisbon/PT

Purpose – Analyze the individual baseline parameters to predict the outcome of prostatic artery embolization (PAE) for benign prostatic hyperplasia (BPH).

Materials and Methods – Retrospective study (March 2009 – September 2011). Poor outcome after PAE considered when 1 criteria was met: International Prostate Symptom Score (IPSS) ≥ 20 and/or reduction < 25%; Quality of Life (QoL) ≥ 4 and/or reduction < 1; peak urinary flow (Qmax) improvement < 2.5 mL/s; additional treatments required.

Results – PAE performed in 113 patients (mean follow-up 7.6 months). Poor outcome (Group A): 33 patients (29.2%); Good outcome (Group B): 80 patients (70.8%). In Group A 12.1% (n=4) and in Group B 11.3% (n=9) of patients were under acute urinary retention before PAE. Mean baseline parameters (age/prostate volume/PSA/IPSS/QoL/Qmax/Post-void residual volume – PVR) Group A: 67.5 years / 76.4 mL / 4.9 ng/mL / 24.3 / 4.1 / 7.7 mL/s / 132.9 mL; Group B: 66 years / 84 mL / 6.1 ng/mL / 23 / 4.2 / 8.7 mL/s / 96.3 mL. Unilateral embolization performed in 7 patients from Group A (21.2%) and 9 patients from Group B (11.3%). In Group A 8 patients (24.2%) had poor outcome based only on Qmax parameters. Thus, based only on clinical parameters, there was a poor outcome in 22.1% (n=25) of patients.

Conclusion – Between 20% – 30% of patients may have poor outcome after PAE for BPH. Higher PVR and unilateral embolization were associated with a poor outcome. The remaining baseline parameters did not correlate with outcome.

Oral Scientific Presentation – Featured paper – 1402.3 Prostatic arterial embolization: criteria to predict treatment outcome. T. Bilhim, J.M. Pisco, H. Rio Tinto, L. Fernandes, J.A. Pereira, M. Duarte, L.C. Pinheiro, A.G. Oliveira, J. O’Neill; Lisbon/PT

Purpose

To evaluate the safety, morbidity, short- and medium-term results of prostatic arterial embolization (PAE) for symptomatic benign prostatic hyperplasia (BPH) after failure of medical treatment.

Material and Methods

Prospective, nonrandomized study includes 208 consecutive patients; age ranged between 45 and 85 years (mean age 73.9 years). PAE was performed with nonspherical 100μm and 200μm polyvinyl alcohol (PVA) particles. IPSS, QoL, Qmax, PVR, Prostate volume and IIEF were evaluated before PAE and at 1, 3, 6 and every 6 months after PAE .The patients were evaluated between 1 and 30 months (mean 14,8). Clinical improvement was considered if there was reduction of IPSS equal or superior to 25% of the total score and lower than 15, reduction of QoL at least 1 point and ≤ 3 and increase of Qmax ≥ 2.5 ml/s.

Results

PAE was technically successful in 204 patients (98.1%). There was clinical improvement at 1 month in 88.4%, at 3 months in 84.6%, at 6 months in 78.4%, at 12 months in 75.7%, at 18 months in 72.1%, and 24 months in 70.2%. There was one major complication a small bladder ischemia of bladder wall that was removed and some minor complications.

Conclusion

PAE is a safe procedure with low morbidity and good short- and medium-term results.

Clinical outcome after prostatic artery embolization: unilateral versus bilateral embolization. T. Bilhim, J.M. Pisco, H. Rio Tinto, L. Fernandes, J.A. Pereira, M.  Duarte, L.C. Pinheiro, A.G. Oliveira, J. O’Neill; Lisbon/PT

Purpose – To compare clinical outcome in patients with unilateral and bilateral prostatic artery embolization (PAE) for benign prostatic hyperplasia (BPH).

Materials and Methods – Retrospective study (March 2009 – December 2011) in 122 patients. Bilateral PAE was performed in 103 patients (Group A; mean follow-up 6.9 months); unilateral PAE in 19 patients (Group B; mean follow-up 8.1 months).

Results – In Group A 10.7% (n=11) and in Group B 10.5% (n=2) of patients were under acute urinary retention before PAE. Mean baseline parameters (age/prostate volume/PSA/IPSS/QoL/Qmax/Post-void residual volume – PVR) Group A: 66 years / 84 mL / 5.5 ng/mL / 23 / 4.2 / 8.6 mL/s / 102.1 mL; Group B: 71 years / 75.8 mL / 7.5 ng/mL / 22 / 3.9 / 8 mL/s / 116.2 mL. Mean prostate volume reduction: 23.5% (19.75 mL) in Group A; 13.3% (10.1 mL) in Group B. Mean PSA reduction 1.4 ng/mL in Group A; 0.8 ng/mL in Group B. Mean IPSS/QoL improvement 12.6/2.1 in Group A; 9.25/1.5 in Group B. Mean Qmax improvement 4.15 mL/s in Group A; 3 mL/s in Group B. Mean PVR reduction 36.2 mL in Group A; 47.45 in Group B. Poor clinical outcome in 25.2% of patients from Group A (n=26) and in 47.4% of patients from Group B (n=9).

Conclusion – Bilateral PAE is associated with greater prostate volume, PSA, IPSS/QoL reductions, and greater Qmax improvement. Clinical outcome is better when bilateral embolization is performed, however up to 50% of patients have good clinical outcome after unilateral PAE.

Oral Scientific Presentation – 2202.6 Polyvinyl alcohol particle size for prostatic artery embolization: a prospective randomized study of 100 μm particles versus 200 μm particles. T. Bilhim, J.M. Pisco, H. Rio Tinto, L. Fernandes, J.A. Pereira, M. Duarte, L.C. Pinheiro, A.G. Oliveira, J. O’Neill; Lisbon/PT

Purpose – Evaluate whether different polyvinyl alcohol (PVA) particle sizes change the outcome of prostatic artery embolization (PAE) for Benign Prostatic Hyperplasia (BPH).

Materials and Methods – Randomized prospective study, 80 patients with BPH undergoing PAE (May – December 2011). PAE was performed with 100 µm particles in 40 patients (Group A); and 200 µm particles in 40 patients (Group B). Pain was measured (0 – 10) during PAE, after 4–8 hours and the week following PAE. Complication rates were compared. The outcome of PAE was evaluated by IPSS, QoL and IIEF measurements, prostate volume reduction, PSA, Qmax and PVR measurements at 3 and 6 months.

Results – Patients lost to follow-up: 3 (Group A); 5 (Group B). Mean PVA volume used: 0.33cc in Group A; 0.4cc in Group B. Mean pain scores during embolization: 3.2 (group A); 2.9 (group B); after embolization, mean pain scores: 0.1 (group A) and 0 (group B). There were no statistically significant differences in the minor complication rates, with no major complications. Mean IPSS/QoL reduction: 8.9/1.9 (Group A); 10.4/2.1 (Group B); mean prostate volume reduction: 19% (Group A); 18% (Group B). Poor clinical outcome: 18.9% (Group A); 8.6% (Group B).

Conclusion – No significant differences were noted in pain severity or complication rates after PAE for BPH using 100 µm or 200 µm PVA particles. The clinical outcome at 3 and 6 months seems to be slightly better with 200 µm PVA particles.

Embolization for symptomatic benign prostatic hyperplasia after failure of medical therapy

J.M. Pisco, L.C. Pinheiro, T. Bilhim, H. Rio Tinto, M. Duarte, L. Fernandes, J.A. Pereira, J. O’Neill, A.G. Oliveira; Lisbon

Purpose – To evaluate the safety, morbidity, short- and medium-term results of prostatic arterial embolization (PAE) for symptomatic benign prostatic hyperplasia (BPH) after failure of medical treatment.Material and Methods – Prospective, nonrandomized study includes 208 consecutive patients; age ranged between 45 and 85 years (mean age 73.9 years). PAE was performed with nonspherical 100μm and 200μm polyvinyl alcohol (PVA) particles. IPSS, QoL, Qmax, PVR, Prostate volume and IIEF were evaluated before PAE and at 1, 3, 6 and every 6 months after PAE .The patients were evaluated between 1 and 30 months (mean 14,8). Clinical improvement was considered if there was reduction of IPSS equal or superior to 25% of the total score and lower than 15, reduction of QoL at least 1 point and ≤ 3 and increase of Qmax ≥ 2.5 ml/s.Results – PAE was technically successful in 204 patients (98.1%). There was clinical improvement at 1 month in 88.4%, at 3 months in 84.6%, at 6 months in 78.4%, at 12 months in 75.7%, at 18 months in 72.1%, and 24 months in 70.2%. There was one major complication a small bladder ischemia of bladder wall that was removed and some minor complications.Conclusion – PAE is a safe procedure with low morbidity and good short- and medium-term results.
Prostatic arterial embolization: Criteria to predict treatment outcome
T. Bilhim, J.M.Pisco, H. Rio Tinto, l. Fernandes, J.A. Pereira,m. Duarte, l.C. Pinheiro, A.G. Oliveira, J’Oneill
1402.

14 – Posters CIRSE 2012

CIRSE 2012 – Educational Poster – P-90 MR and endorectal US findings in benign prostatic hyperplasia before and after prostatic artery embolization. T. Bilhim, J.M. Pisco, H. Rio Tinto, L. Fernandes, J.A. Pereira, M. Duarte, L.C. Pinheiro, A.G. Oliveira, J. O’Neill; Lisbon/PT – Certificate of Merit.

Learning Objectives – To review the US and MR imaging findings in benign prostatic hyperplasia (BPH) before and after prostatic artery embolization (PAE).

Background – BPH is associated with central gland enlargement and peripheral gland compression. Central gland nodules may have varied US and MR appearences and the median lobe may protude into the bladder pavement, distorting the bladder neck. MRI findings after ablative techniques for BPH are usually associated with hypoenhancing areas in the central gland, and hypoechoic nodules on US. Prostate volume and clinical findings do not correlate directly in BPH patients before or after treatment.

Clinical Findings/Procedure Details – Pictorial review of the major MR and endorectal US findings in BPH. Special focus will be given on the imaging findings after PAE, including median lobe reduction, central gland modifications (hypointense nodules on T2WI and hypoechoic nodules on US), hypoenhancing areas in the central gland and prostate volume reduction. Imaging findings will be correlated with clinical outcome and varied examples will be shown.

Conclusion – After PAE there is a mean prostate volume reduction of 25% in approximately 75% of patients, with hypointense nodules on T2WI; hypoechoic on US, hypoenhancing areas in the central gland, and median lobe reduction. Prostate volume reduction does not occur in all patients and does not correlate directly with clinical outcome.

PAE for patients with symptomatic benign prostatic hyperplasia and prostate larger than 100cc

João Martins Pisco, Tiago Bilhim, Hugo Rio tinto, José Pereira, Marisa  Duarte

Purpose – To evaluate the outcome of prostatic artery embolization (PAE), in patients with symptomatic benign prostatic hyperplasia (BPH) and prostate larger than 100cc.

Material and Methods – Forty-one patients with symptomatic BPH, and prostate larger than 100cc were treated by PAE. Age ranged between 48 and 85 years (mean 74.8 years). Before PAE the prostate volume ranged between 100cc and 270cc (mean 134.6), the IPSS between 17 and 35 (mean 23.9) and the QoL between 3 and 6 (mean 4.3). Nonspherical PVA particles 100μm or 200μm were used. The control follow-up was performed between 1 and 30 months (mean 12.5 months) after PAE.

Results – PAE was technically successful in 40 of the 41 patients (97.6%) and the embolization was bilateral in 37 patients (92.5%) and unilateral in 3 patients. At last follow-up control there was clinical improvement in 30 of the 40 patients (75%). In these patients the mean prostate volume reduced from 134.6cc to 91.7cc (31.9%), the IPSS reduced from 23.9 to 10.1 (57.7%) and the QoL from 4.3 to 1.9 (55.8%).

Conclusion – PAE in patients with symptomatic BPH and prostate larger than 100cc is an efficient procedure with good results at short and medium term.

Clinical outcome after prostatic artery embolization in patients under acute urinary retention

Lúcia Fernandes, Hugo Rio Tinto, Tiago Bilhim, Marisa Duarte, José Pereira, Luís Campos Pinheiro, Joao Martins Pisco

Purpose – To evaluate clinical outcome after prostatic artery embolization (PAE) in patients with benign prostatic hyperplasia ( BPH) under acute urinary retention (AUR).

Material and Methods – We retrospectively review the clinical and imaging findings of 13 ( 11,5%) patients under AUR, all with urinary catheter, of the 113 patients that underwent prostatic artery embolization at our institution, from March 2009 to September 2011.

Poor outcome after PAE considered when 1 criteria was met: still with urinary catheter; International Prostate Symptom Score (IPSS) ≥ 20 and/or reduction < 25%; Quality of Life (QoL) ≥ 4 and/or reduction < 1; peak urinary flow (Qmax) improvement < 2.5 mL/s; additional treatments required.

Results – PAE performed in 13 patients with AUR (mean follow-up 7.6 months). Poor outcome of the patients with AUR (Group A): 30,8 % (n=4) Good outcome (Group B): 69,2% (n=9) .

Conclusion – Despite the reduced number of patients (n=13), PAE seems to be a promising new procedure in patients with BPH and acute urinary retention.

 

Male pelvic arteries revisited: an anatomical-radiological pictorial assay

J.A.Pereira; H.A. Rio Tinto; L. Fernandes; M. Duarte; T. Bilhim; J.M.Pisco

Learning objectives: To review the radiological anatomy of the male internal iliac artery (IIA) using angio CT and digital subtraction angiography (DSA).

Background: Embolization of pelvic arteries is performed in a vast number of clinical settings and a growing interest has been noted in prostatic artery embolization (PAE) for benign prostatic hyperplasia (BPH). In order to avoid untargeted ischemic complications after selective pelvic arterial embolization knowledge of the radiological anatomy of the IIA is essential.

Clinical findings/procedure details: Pictorial review of over 200 male pelvic sides evaluated with Angio CT and DSA before embolization for various reasons. IIA have been classified by Yamaki in 4 groups according to the pattern of bifurcation of their main collateral branches (the superior gluteal, the inferior gluteal and the internal pudendal arteries). Another large artery that may be found in the pelvis is the obturator artery that arises from the IIA in 2/3 of cases and from the epigastric artery in the remaining 1/3. One important anatomical variant is the accessory pudendal artery that may be found in up to 20% of pelvic sides. In this educational presentation we will review the anatomical and radiological features of the main collateral vessels of the IIA, also focusing on smaller vessels as the prostatic, vesical and rectal arteries. ´

Conclusion: The most frequent pattern of IIA bifurcation is the Type A, followed by types B and C. After being familiarized with the larger IIA collaterals, identification of smaller vessels (prostatic, vesical or rectal arteries) becomes easier.

13 – Initial expirience with embozene microspheres for prostatic artery embolization: technical and clinical outcomes

H.Rio Tinto; T. Bilhim; L.Fernandes; M.Duarte; J.A.Pereira; L.C.Pinheiro; J.M.Pisco


12 – Thiking outside the pelvic box: an antlas of unusual prostatic arterial supply for prostatic artery embolization

Hugo Rio Tinto, Tiago Bilhim, L.Fernandes, M.Duarte, J.A.Pereira, L.C.Pinheiro, J.M.Pisco

11 – How to perform prostatic artery embolization: Clinical and technical challenges

H.Rio Tinto; T. Bilhim; L.Fernandes; M.Duarte; J.A.Pereira; L.C.Pinheiro; J.M.Pisco

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10 – How, when and why to perform selective embolization of terminal branches of the male internal pudendal artery in the treatment of hight-flow arterial priaprism

J.A.Pereira;H.Rio Tinto; L.Fernandes; M.Duarte; T. Bilhim; J.M.Pisco;  Interventional Radiology, Saint Louis Hospital

273-p.

9 – Prostatic Arterial Embolization for Benign Prostatic Hyperplasia: Short and Intermediate-term Results

Pisco J, Campos Pinheiro L, Bilhim T, Duarte M, Rio Tinto H, Fernandes L, Vaz Santos V, Oliveira AG

8 – 40 European association of Urology poster

Eur. Urol. Suppl 2013;12;e628

JVIR 2011;22 (1):21-7

INTRODUCTION & OBJECTIVES:

To evaluate the clinical outcome of Prostatic Artery Embolization (PAE) for 365

patients with Benign Prostatic Hyperplasia (BPH) and moderate to severe lower urinary tract symptoms (LUTS).

MATERIAL & METHODS:

Single center cohort study. 365 consecutive patients with BPH and moderate to severe

(LUTS) underwent PAE. The age ranged between 45 and 89 years (mean 68,7 years) and the prostate volume

between 40 to 270cc (mean 89cc). Seventy two patients had prostates larger than 100cc and 42 patients were in acute

urinary retention with bladder catheter. International Prostate Symptom Score (IPSS), Quality of Life (Qol),

International Index Erectile Function (IIEF), Quality of Life (Qmax), prostate volume (PV), Post-void residual volume

(PVR) and PSA were evaluated before and at 1, 3, 6 and every 6 moths after the procedure, in order to access the

clinical outcome. The follow up control ranged from 1 to 42 months (mean 14 months). PAE was performed under local

anaesthesia. As embolic material, nonspherical PVA – 100

m 200m particles were used. Clinical success was

considered as symptoms improvement (IPSS reduction at least 25% of the total score and lower than 15 points),

quality of life improvement (reduction of Qol at least 1 point and or equal or lower to 3 points) and no need of medical

therapy or any other treatment after PAE.

RESULTS:

All patients were treated as outpatients. Thirteen patients were lost to follow up. From the 352 controlled

patients there were 86 clinical failures, 54 (15, 3%) at short term and 32 at mid term. The best results were shown in

patients with prostates larger than 100cc and severe symptoms (IPSS >20). Mean IPSS/QoL reduction: 10.9/2.8; mean

PV reduction 16.2%. PAE was repeated in 12 patients with clinical failure and there was clinical success in 8. From the

other patients with clinical failure, 8 were treated by TURP, 3 had open prostatectomy and the remaining are under

medical therapy. Cumulative rates of clinical success at short term were at 3 months 84.9%, at 6 months 80.5%, at 12

months 77.2%, at medium term at 18 months 76.9%, at 24 months 74.3 %, at 30 months 74.3% and at 36 months

74.3% and at 42 months 74.3%. As a major complication there was just a bladder wall ischemia treated by simple

surgery and some minor complications.

CONCLUSIONS:

PAE is a safe, outpatient procedure for patients with BPH and moderate to severe (LUTS), with good

short and mid-term results, particularly in patients with prostate larger than 100cc and severe symptoms.

7 –   SIR 2013 – Comunicações Livres

1. Predictive factors of poor clinical outcome after prostatic arterial embolization for BPH

Tiago Bilhim, Joao Martins Pisco, Hugo Rio Tinto, Lúcia Fernandes, José Pereira, Marisa Duarte, Luís Campos Pinheiro, António Oliveira, João E. G. O’Neill

<<

Purpose – Analyze the individual baseline parameters to predict the outcome of prostatic artery embolization (PAE) for benign prostatic hyperplasia (BPH).

 

Materials and Methods – Retrospective study (March 2009 – March 2012). Poor outcome after PAE considered when 1 criteria was met: International Prostate Symptom Score (IPSS) ≥ 20 and/or reduction < 25%; Quality of Life (QoL) ≥ 4 and/or reduction < 1; additional treatments required.

 

Results PAE performed in 172 patients (mean follow-up 9.6 months; range 3-24 months). Poor outcome (Group A): 53 patients (30.8%, mean follow-up 11.0 months); Good outcome (Group B): 119 patients (69.2%, mean follow-up 9.0 months). In Group A 11.3% (n=6) and in Group B 12.6% (n=15) of patients were under acute urinary retention before PAE (p=0.5). In Group A 37.7% (n=20) and in Group B 28.6% (n=34) of patients were medicated with 5-alpha reductase inhibitors before PAE (p=0.3). Mean baseline parameters (age/prostate volume/PSA/IPSS/QoL/Qmax/Post-void residual volume – PVR) – Group A: 67.3 years / 81.1 mL / 4.9 ng/mL / 23.9 / 4.5 / 9.0 mL/s / 100.0 mL; Group B: 64.7 years / 84.0 mL / 5.9 ng/mL / 23.5 / 4.2 / 9.3 mL/s / 97.6 mL (p>0.05). Unilateral embolization performed in 11 patients from Group A (20.8%) and 14 patients from Group B (11.8%) (p=0.2).

PAE performed with 100 μm PVA particles in 45.3% (Group A) and 32.8% (Groups B) of patients; PAE performed with 200 μm PVA particles in 22.6% (Group A) and 32.8% (Groups B) of patients; PAE performed with 100 + 200 μm PVA particles in 18.9% (Group A) and 21.9% (Groups B) of patients; PAE performed with 300-500 μm microspheres in 13.2% (Group A) and 12.6% (Groups B) of patients (p=0.4). In Group A there were 40 (75.5%) non-responders and 13 (24.5%) relapses.

 

Conclusion – Approximately 30% of patients may have poor outcome in the first year after PAE for BPH and most are non-responders. There were no statistically significant differences in the baseline parameters between patients with poor and good clinical outcome. Unilateral embolization and PAE with 100 μm PVA particles were more frequent in patients with poor clinical outcome.

2. Size for prostatic artery embolization: a prospective randomized study of 100 μm particles versus 200 μm particles

 Tiago Bilhim, Joao Martins Pisco, Hugo Rio Tinto, Lúcia Fernandes, José Pereira, Marisa Duarte, Luís Campos Pinheiro, António Oliveira, João E. G. O’Neill

 

Purpose – Evaluate whether different polyvinyl alcohol (PVA) particle sizes change the outcome of prostatic artery embolization (PAE) for Benign Prostatic Hyperplasia (BPH).

 

Materials and Methods – Randomized prospective study, 80 patients with BPH undergoing PAE (May – December 2011). PAE was performed with 100 µm particles in 40 patients (Group A); and 200 µm particles in 40 patients (Group B). Pain was measured (0 – 10) during PAE, after 4–8 hours and the week following PAE. Complication rates were compared. The outcome of PAE was evaluated by IPSS, QoL and IIEF measurements, prostate volume reduction, PSA, Qmax and PVR measurements at 3 and 6 months.

 

Results Patients lost to follow-up: 2 (Group A); 5 (Group B). Mean baseline data between groups (age; prostate volume; PSA; IPSS/QoL; Qmax; post-void residual volume; acute urinary retention rate): 64.4 years; 78.4 mL; 5.4 ng/mL; 22.5/4.7 points; 8.1 mL/s; 106.8 mL; 7.9% (n=3) in Group A; 63.9 years; 81.9 mL; 9.0 ng/mL; 22.3/4.3 points; 10.2 mL/s; 90.9 mL; 8.6% (n=3) in Group B. Mean PVA volume used: 0.33cc in Group A; 0.4cc in Group B. Unilateral PAE – 18.4% (n=7) in Group A; 22.9% (n=8) in Group B. Mean pain scores during embolization: 3.3 (group A); 3.3 (group B); after embolization, mean pain scores: 0.1 (group A) and 0 (group B). There were no statistically significant differences in the minor complication rates, with no major complications. Mean IPSS/QoL reduction: 6.0/1.7 (Group A); 10.7/1.9 (Group B); mean prostate volume reduction: 14.7% (Group A); 6% (Group B). Poor clinical outcome: 47.4% (n=18, Group A); 25.7% (n=9, Group B); p=0.04.

 

Conclusion – No significant differences were noted in pain severity or complication rates after PAE for BPH using 100 µm or 200 µm PVA particles. The clinical outcome at 3 and 6 months was significantly better with 200 µm PVA particles, but there was a greater prostate volume and PSA reduction with 100 µm PVA particles.

3. Unilateral Versus Bilateral Prostatic arterial embolization in patients with benign prostatic hyperplasia

Tiago Bilhim, Joao Martins Pisco, Hugo Rio Tinto, Lúcia Fernandes, José Pereira, Marisa Duarte, Luís Campos Pinheiro, António Oliveira, João E. G. O’Neill

  

Purpose – To compare baseline data and clinical outcome between patients with Prostate Enlargement/Benign Prostatic Hyperplasia (PE/BPH) who underwent unilateral and bilateral Prostatic Arterial Embolization (PAE) for the relief of Lower Urinary Tract Symptoms (LUTS).

 

Materials and Methods Single center ambispective cohort study in 122 consecutive patients (mean patient age 66.7 years) comparing patients with unilateral versus bilateral PAE (March 2009 – September 2011). Selective PAE with 100 μm and 200 μm nonspherical polyvinyl alcohol (PVA) particles. The outcome of PAE was evaluated by International Prostate Symptom Score (IPSS), Quality of Life (QoL) and International Index of Erectile Functio (IIEF) measurements, prostate volume (PV) reduction, PSA, Peak Urinary Flow-rate (Qmax) and Post-void Residual Volume (PVR) measurements. Poor outcome after PAE considered when 1 criteria was met: IPSS ≥ 20 and/or reduction < 25%; QoL ≥ 4 and/or reduction < 1; Additional treatments required.

 

Results Mean follow-up 7.1 months (range 3 –12 months). Group A – Bilateral PAE – 103 (84.4%) patients; Group B -Unilateral PAE – 19 (15.6%) patients. Mean procedural time 81.5 minutes (range 26 – 182 minutes). Mean fluoroscopy time 26.4 minutes (range 8 – 61 minutes). Mean procedural pain score 3.3 points (0-10 scale). Mean pain score after PAE (before discharge) 0.3 points (0-10 scale). Patients from Group B were significantly older (mean age 71.3 ± 1.7 years, p=0.002), the remaining baseline parameters did no differ significantly.Mean PV reduction of 18.2 ± 22.1 mL (19.2%, p<0.0001); Mean PSA reduction of 1.73 ± 4.33 ng/mL (30.9%, p<0.0001); Mean IPSS/QoL improvement of 11.3 ± 8.74/1.93 ± 1.52 points (44.8%/44.2%, p<0.0001);Mean Qmax improvement of 4.00 ± 4.75 mL/s (65.0%, p<0.0001) Mean PVR reduction of 35.9 ± 93.2 mL (0,5%, p=0.002); IIEF improved 1.55 ± 6.44 points (23.6%, p=0.017).In Group A PV volume reduced more 7.9 mL ; IPSS reduced more 2.9 points and the QoL 0.6 points (p>0.05). PSA, Qmax and PVR improvements after PAE did not differ significantly between groups.Poor clinical outcome: Group B 47.4%; Group A 24.3% (23.1% difference, p=0.04).

 

Conclusion –PAE is a challenging technique with up to 15% of patients with unilateral embolization. PAE is safe and effective inducing 45% improvement in the IPSS score and a prostate volume reduction of 18%. Bilateral PAE is associated with better clinical results. Up to 50% of patients with unilateral PAE may have a good clinical outcome.

4. Best embolic agent for prostatic artery embolization in BPH patients: a prospective randomized study of 300-500 μm tris-acryl gelatin microspheres versus 100+200 μm PVA particles

L. Fernandes, J.M. Pisco, T. Bilhim, H. Rio Tinto, J.A. Pereira, M. Duarte,  Saint Louis hospital/Interventional Radiology, Lisbon/PT

Purpose – Compare the clinical outcome of prostatic artery embolization (PAE) for Benign Prostatic Hyperplasia (BPH) using 300-500 μm tris-acryl gelatin microspheres versus 100+200 μm PVA particles.

Materials and Methods – Randomized prospective study, 80 patients with BPH undergoing PAE (January- May 2012). PAE was performed with 300-500 μm tris-acryl gelatin microspheres (MS) in 40 patients (Group A); and 100+200 μm PVA particles in 40 patients (Group B). Pain was measured (0 – 10) during PAE, after 4–8 hours and the week following PAE. Complication rates were compared. The outcome of PAE was evaluated by IPSS, QoL and IIEF measurements, prostate volume reduction, PSA, Qmax and PVR measurements at 3 and 6 months.

Results – Patients lost to follow-up: 5 (Group A); 7 (Group B). Mean embolic volume used: 0.6mL MS in Group A; 0.5mL PVA in Group B. Mean pain scores during embolization: 1.5 (group A); 3.2 (group B); after embolization, mean pain scores: 0.1 (group A) and 0.2 (group B). There were no statistically significant differences in the minor complication rates, with no major complications. Mean IPSS/QoL reduction: 11.2/2.0 (Group A); 12/2.3 (Group B); mean prostate volume reduction: 19% (Group A); 24% (Group B). Poor clinical outcome: 21.2% (Group A); 22% (Group B).

Conclusion – No significant differences were noted in pain severity, complication rates or clinical outcome after PAE for BPH using 300-500 µm MS or 100+200 µm PVA particles.

6 –  SIR 2013, New Orleans

Prostatic Arterial Embolization: Can MR findings predict treatment outcome?

T. Bilhim, J.M. Pisco, H. Rio Tinto, L. Fernandes, J. Pereira, M. Duarte, L. Campos Pinheiro, A. Oliveira, J.E. O’Neill; Interventional Radiology, Saint Louis Hospital, Lisbon, Portugal;

1

4961f5add1517154-1

 

 

 5 – Poster

SIR 2013 – Prostatic arterial embolization: can MR findings predict treatment outcome? Accepted for Poster presentation P-257. T. Bilhim, J.M. Pisco, H. Rio Tinto, L. Fernandes, J.A. Pereira, M. Duarte, L.C. Pinheiro, A.G. Oliveira, J. O’Neill; Lisbon/PT. –Poster award.

 

Poster Award.pdf-page-001

 

Tiago Bilhim, Joao Martins Pisco, Hugo Rio Tinto, Lúcia Fernandes, José Pereira, Marisa Duarte, Luís Campos Pinheiro, António Oliveira, João E. G. O’Neill

 

Purpose – Evaluate if MR findings after prostatic artery embolization (PAE) for benign prostatic hyperplasia (BPH) can predict treatment outcome.

 

Materials and Methods – Prospective study (January 2012 – July 2012). Contrast-enhanced MR (injection of 0.2mmol/kg gadolinium chelate at 3mL/s)

was performed using a 1.5T scanner before and after PAE for BPH in 25 patients (mean age 62.8 ± 7.9 years). Poor outcome after PAE considered when 1 criteria was met: International Prostate Symptom Score (IPSS) ≥ 20 and/or reduction < 25%; Quality of Life (QoL) ≥ 4 and/or reduction < 1; additional treatments required.

 

Results –Contrast-enhanced MR was performed 3 months after PAE in 4 patients and in the first month after PAE in the remaining 21 patients.Five patients (20%) had ischemic changes > 50% on MR (all in the first month after PAE) – Group A – all embolized with PVA 100 + 200 μm; mean prostate volume reduction of 17%; all with good clinical outcome; mean IPSS/QoL reduction of 14.2/2.4 points. Seven patients (28%) with ischemic changes < 50% on MR (all in the first month after PAE) – Group B – 4 patients embolized with PVA 100 + 200 μm; 3 patients embolized with 300-500 μm microspheres; mean prostate volume reduction of 11%; 2 patients (28.6%) with poor clinical outcome; mean IPSS/QoL reduction of 10.1/1.9 points. Thirteen patients (52%) without ischemic changes on MR (4 patients: 3 months after PAE; 8 patients: in the first month after PAE) – Group C – 2 patients embolized with PVA 100 μm and 4 with PVA 200 μm; 4 patients embolized with PVA 100 + 200 μm; 3 patients embolized with 300-500 μm microspheres; mean prostate volume reduction of 14%; 5 patients (38.5%) with poor clinical outcome; mean IPSS/QoL reduction of 9.2/1.4 points. Twelve patients (48%) with ischemic changes on MR – 2 had poor clinical outcome (16.7%).

 

Conclusion – Approximately half of the patients have ischemic changes on contrast-enhanced MR in the first month after PAE. The greatest ischemic changes were found with 100 + 200 μm PVA particles. Higher ischemic changes were associated with better clinical outcome. Prostate volume reduction did not correlate with ischemic changes or clinical outcome.

 

4 –  CLINICAL OUTCOME OF PROSTATIC ARTERIAL EMBOLISATION FOR PATIENTS WITH BENIGN PROSTATIC HYPERPLASIA AND MODERATE TO SEVERE LOWER URINARY TRACT SYMPTOMS – 365 CASES

42 European Association of Urology – Posters Apresentados

Luis Campos Pinheiro*, Joa˜o Pisco, Hugo Rio Tinto, Tiago Bilhim,

Lucia Fernandes, Marisa Duarte, Jose´ Pereira,

Antonio Gouveia Oliveira

INTRODUCTION AND OBJECTIVES: To evaluate the clinical

outcome of Prostatic Artery Embolization (PAE) for 365 patients with

Benign Prostatic Hyperplasia (BPH) and moderate to severe lower

urinary tract symptoms (LUTS).

METHODS: Single center cohort study in 365 consecutive

patients with BPH and moderate to severe (LUTS) underwent PAE.

The age ranged between 45 and 89 years (mean 68, 7 years and the

prostate volume between 40 to 270cc (mean 89cc). Seventy two

patients had prostates larger than 100cc and 42 patients were in acute

urinary retention with bladder catheter. International Prostate Symptom

Score (IPSS), Quality of Life (Qol), International Index Erectile Function

(IIEF), Quality of Life (Qmax), prostate volume (PV), Post-void residual

volume (PVR) and PSA were evaluated before and at 1, 3, 6 and every

6 moths after the procedure, in order to access the clinical outcome.

The follow up control ranged from 1 to 42 months (mean 14 months).

PAE was performed under local anaesthesia. As embolic material,

nonspherical PVA – 100m 200m particles were used. Clinical success

was considered as symptoms improvement (IPSS reduction at

least 25% of the total score and lower than 15 points), quality of life

improvement (reduction of Qol at least 1 point and or equal or lower to

3 points) and no need of medical therapy or any other treatment after

PAE.

RESULTS: All patients were treated as outpatients. Thirteen

patients were lost to follow up. From the 352 controlled patients there

were 86 clinical failures, 54 (15, 3%) at short term and 32 at mid term.

The best results were shown in patients with prostate lager than 100cc

and severe symptoms (IPSS 20). Mean IPSS/QoL reduction: 10.9/

2.8; mean PV reduction 16.2%. PAE was repeated in 12 patients with

clinical failure and there was clinical success in 8. From the other

patients with clinical failure, 8 were treated by TURP, 3 had open

prostatectomy and the remaining are under medical therapy. Cumulative

rates of clinical success at short term were at 3 months 84.9%, at

6 months 80.5%, at 12 months 77.2%, at medium term at 18 months

76.9%, at 24 months 74.3 %, at 30 months 74.3% and at 36 months

74.3% and at 42 months 74.3%. As a major complication there was just

a bladder wall ischemia treated by simple surgery and some minor

complications.

CONCLUSIONS: PAE is a safe, outpatient procedure for patients

with BPH and moderate to severe (LUTS), with good short and

mid-term results, particularly in patients with prostate larger than 100cc

and severe symptoms.

Source of Funding: none

3 –  PROSTATIC ARTERIAL EMBOLIZATION FOR PATIENTS WITH BENIGN PROSTATIC HYPERPLASIA AND ACUTE URINARY RETENTION WITH A BLADDER CATHETER

Luis Campos Pinheiro*, Lucia Fernandes, Joa˜o Pisco,

Hugo Rio Tinto, Tiago Bilhim, Marisa Duarte, Jose´ Pereira,

Antonio Gouveia Oliveira

INTRODUCTION AND OBJECTIVES: To evaluate the results

of prostatic arterial embolization (PAE) for patients with benign prostatic

hyperplasia (BPH) and acute urinary retention (AUR) with bladder

catheter.

METHODS: Forty two patients aged 48 to 81 years with BPH,

AUR and bladder catheter underwent PAE. Prostate volume, Prostatic

Specific Antigen (PSA) and Quality of Life (QoL) were evaluated before

PAE. The prostate volume ranged between 44cc and 191cc (mean

89cc). Sixteen patients had prostates larger than 100cc. PAE was

performed under local anaesthesia and PVA particles sized 100m and

200m were used as embolic material.

International Index Erectile Function (IIEF), Quality of life (QoL),

uroflowmetry, (Qmax – peak urinary flow and PVR – post voiding

residual volume), Prostatic Specific Antigen (PSA) and prostate volume,

were assessed after PAE, at 3, 6 and every 6 months thereafter

to access the clinical outcome. Patients were evaluated between 3 and

42 months (mean 13 months). It was considered clinical success if the

patient could urinate easily after removal of the prostate catheter, the

IPSS lower than to 15 and the QoL reduced at least 1 point and no need

of medical treatment or any other treatment.

RESULTS: All patients were treated as outpatients. There was

one technical failure (2.3%) and one patient was lost to follow-up. There

was short-term clinical success at 3 months in 36/40 (90%). There were

4 (10 %) patients which bladder catheter could not be removed and

were considered short term clinical failures and PAE was repeated. In

3 of them the bladder catheter could be removed, therefore the secondary

clinical success was shown in 39/40 (95.1%) patients. The 4th

patient which catheter could not be removed was treated by open

prostatectomy. At 18 months there were 4/39 (10.3%) mid-term clinical

failures. Three of them were successfully treated with repeated PAE.

The third was treated by open prostatectomy. There was not any major

complication.

CONCLUSIONS: PAE in patients with BPH and AUR is a safe

procedure with good short and mid-term results.

Source of Funding: none

2 –  EMBOLIZATION FOR BENIGN PROSTATIC HYPERPLASIA AND VERY LARGE PROSTATE AS AN ALTERNATIVE TO OPEN SURGERY

Luis Campos Pinheiro*, Joa˜o Pisco, Hugo Rio Tinto, Tiago Bilhim,

Lucia Fernandes, Marisa Duarte, Jose´ Pereira,

Antonio Gouveia Oliveira

INTRODUCTION AND OBJECTIVES: Evaluate outcome of

prostatic arterial embolization (PAE) for symptomatic patients with

benign prostatic hyperplasia (BPH) and very large prostates, after

failure of medical therapy for at least 6 months.

METHODS: This prospective nonrandomized study included 72

patients (aged 48 – 80 years, mean age 67.6

 6.7 years) with a

diagnosis of BPH, very large prostate and moderate to severe lower

urinary tract symptoms (LUTS) after failure of medical treatment for at

least 6 months, selected for prostatic arterial embolization (PAE) between

March 2009 and April 2012. Sixteen patients were in urinary

retention and bladder catheter. The procedure was always performed

under local anaesthesia and mostly by single femoral approach. Nonspherical

Polyvinyl Alcohol Particles (PVA) were used for embolization.

The prostate volume ranged between 100 and 269 cc (mean 129.5



32.3 cc). The International Prostate Symptom Score (IPSS), Quality of

Life (QoL), International Index Erectile Function (IIEF), uroflowmetry,

(Qmax – peak urinary flow and PVR – post voiding residual volume),

Prostatic Specific Antigen (PSA) and prostate volume, were assessed

before PAE, at 1, 3, 6 and every 6 months thereafter. Patients were

evaluated up to 36 months (mean 12.3 months).

RESULTS: PAE was technically successful in 71 of 72 patients

(98.6%). Follow up data was available for 67 patients. Four patients

were lost to follow up. From the total 67 controlled patients there were

16 (23.9%) clinical failures, 9 at short term and 7 at medium term. At

one month there was clinical improvement in 57/67 patients (85.1%).

Cumulative rates of clinical success at short term were at 3 months

85.5%, at 6 months 81.4%, at 12 months 78.5%, and at medium term

at 18 months 69.8% at 24 months 69.8 %, at 30 months 69.8 and at 36

months 69.8 %. There was low morbidity, no major complication and no

sexual dysfunction in this group of patients.

CONCLUSIONS: PAE is a minimally invasive procedure with

good short and medium term results, for BPH patients with prostates

larger than 100cc and moderate to severe lower urinary tract symptoms

after failure of medical therapy, and may be considered an alternative

to surgery.

Source of Funding: none

 

1 – Prostatic Arterial Embolization (PAE) for Symptomatic patients with Benign  Prostatic Hyperplasia – João Martins Pisco

Abstract apresentado no  Asian International medical Symposium 2013 – Junho 22, Seoul

1

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Comentários: 9

  1. Isabel Soares says:

    Gostaria de obter os contactos para marcação de consulta de um familiar, que sofre da doença objecto de publicação do presente artigo.
    Muito Obrigada, Com os Melhores Cumprimentos,
    Isabel Soares
    Cascais, em 13 de Junho de 2010

  2. elizabetep says:

    Exma. sra.

    Poderá marcar consulta para o Hospital de St. Louis pelo e.mail elizabetep@hslouis.pt ou por telefone 213216557.

    Melhores cumprimentos,
    João Martins Pisco

  3. Jorge Alberto de Lamares Lourenço Martins says:

    Exmo. Senhor Professor Doutor
    João Martins Pisco

    Foi-me detectado um adenocarcinoma da próstata do tipo histológico convencional (acinar). Gleason 7 (3 + 4)
    Localização – lobo direito
    Cilindros envolvidos A, B e C
    Percentagem de envolvimento dos cilindros: cerca de 90%.
    Invasão perineural: não documentada.
    Permeação linfática: não documentada.
    Extensão extra-prostática: não documewntada.
    Aguardo resultado de cintigrafia e exames marcados para quarta-feira consistentes em duas TAC: uma à região pélvica e outra abdominal superior.
    Gostaria de saber se tem convenção com a Multicare ou Serv Nac de Saúde e se é problema que possa ser trata por si a fim de marcar a res+etiva consulta se for o caso.
    Melhores cumprimentos
    Jorge Lourenço Martins

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  5. Gaynell So says:

    Hey! This is my 1st comment here so I just wanted to give a quick shout out and say I really enjoy reading your blog posts. Can you suggest any other blogs/websites/forums that go over the same topics? Thanks!

  6. As sports fans know, not all cities are produced equal when we are referring for the passion of its’ fan base. Of course, it will be wonderful if all fans have been as passionate for their group as Red Sox Nation plus the fans that pack “Mile-High” stadium to watch their Denver Broncos.

  7. Many thanks a whole lot for sharing!

  8. Tengo 71 anos hace 11 anos fui sometido a un TURP con bastante éxito, desaparecieron el 90% de los síntomas, inclusive seguí eyaculando, sin fuerza pero bastante, como anécdota les puedo decir que encontraron bastantes piedras en mi próstata., Hace un ano los problemas volvieron, tengo dificultad para orinar, dolor y frecuentes ganas de orinar, si no lo hago el dolor es muy fuerte, mi PSA siempre sale bajo, no sufro de ninguna enfermedad aparte de Prostatitis y Fibromialgia.
    Pregunta:
    Estoy muy interesado en operarme por el Dr.João Martins Pisco o su grupo de médicos, e leído con detenimiento su nueva cirujia y estoy gratamente impresionado por ella y sus resultados., Yo vivo en Lima Perú y me gustaría saber cuanto costaría el operarme en Portugal o en otro país mas cercano a Perú que esten certificados por el DR.João Martins Pisco.

    Desde ya agradezco su fina atención a mi solicitud para liberarme de este padecimiento tan doloroso e incomodo.

    Cordialmente.
    Víctor Flores

  9. Pina says:

    respondi por email

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