Retrospective Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Radiol. Sep 28, 2024; 16(9): 380-388
Published online Sep 28, 2024. doi: 10.4329/wjr.v16.i9.380
Intentionally unilateral prostatic artery embolization: Patient selection, technique and potential benefits
Hippocrates Moschouris, Konstantinos Stamatiou
Hippocrates Moschouris, Department of Radiology, General Hospital “Tzanio”, Piraeus 18536, Greece
Konstantinos Stamatiou, Department of Urology, General Hospital “Tzanio”, Piraeus 18536, Greece
Author contributions: Moschouris H wrote the paper, performed the prostatic artery embolization procedures and imaging studies and collected and analyzed the imaging data; Stamatiou K collected and analyzed the clinical data and was responsible for patient follow up.
Institutional review board statement: The study was reviewed and approved by the General Hospital “Tzanio” Institutional Review Board (Approval No. 15/9-3-2024).
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: Dataset available from the corresponding author at hipmosch@gmail.com. Participants gave informed consent for data sharing.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Hippocrates Moschouris, MD, MSc, PhD, Chairman, Doctor, Department of Radiology, General Hospital “Tzanio”, Zanni and Afentouli 1 Street, Piraeus 18536, Greece. hipmosch@gmail.com
Received: April 16, 2024
Revised: August 8, 2024
Accepted: August 22, 2024
Published online: September 28, 2024
Processing time: 163 Days and 14.5 Hours
Abstract
BACKGROUND

Prostatic artery embolization (PAE) is a promising but also technically demanding interventional radiologic treatment for symptomatic benign prostatic hyperplasia. Many technical challenges in PAE are associated with the complex anatomy of prostatic arteries (PAs) and with the systematic attempts to catheterize the PAs of both pelvic sides. Long procedure times and high radiation doses are often the result of these attempts and are considered significant disadvantages of PAE. The authors hypothesized that, in selected patients, these disadvantages could be mitigated by intentionally embolizing PAs of only one pelvic side.

AIM

To describe the authors’ approach for intentionally unilateral PAE (IU-PAE) and its potential benefits.

METHODS

This was a single-center retrospective study of patients treated with IU-PAE during a period of 2 years. IU-PAE was applied in patients with opacification of more than half of the contralateral prostatic lobe after angiography of the ipsilateral PA (subgroup A), or with markedly asymmetric prostatic enlargement, with the dominant prostatic lobe occupying at least two thirds of the entire gland (subgroup B). All patients treated with IU-PAE also fulfilled at least one of the following criteria: Severe tortuosity or severe atheromatosis of the pelvic arteries, non-visualization, or visualization of a tiny (< 1 mm) contralateral PA on preprocedural computed tomographic angiography. Intraprocedural contrast-enhanced ultrasonography (iCEUS) was applied to monitor prostatic infarction. IU-PAE patients were compared to a control group treated with bilateral PAE.

RESULTS

IU-PAE was performed in a total 13 patients (subgroup A, n = 7; subgroup B, n = 6). Dose-area product, fluoroscopy time and operation time in the IU-PAE group (9767.8 μGy∙m2, 30.3 minutes, 64.0 minutes, respectively) were significantly shorter (45.4%, 35.9%, 45.8% respectively, P < 0.01) compared to the control group. Clinical and imaging outcomes did not differ significantly between the IU-PAE group and the control group. In the 2 clinical failures of IU-PAE (both in subgroup A), the extent of prostatic infarction (demonstrated by iCEUS) was significantly smaller compared to the rest of the IU-PAE group.

CONCLUSION

In selected patients, IU-PAE is associated with comparable outcomes, but with lower radiation exposure and a shorter procedure compared to bilateral PAE. iCEUS could facilitate patient selection for IU-PAE.

Keywords: Prostatic artery embolization; Unilateral; Computed tomographic angiography; Dose area product; Fluoroscopy time; Prostatic infarction

Core Tip: In this retrospective study, intentionally unilateral prostatic artery embolization (IU-PAE) was performed in 13 patients with opacification of more than half of the contralateral prostatic lobe after angiography of the ipsilateral prostatic artery or with markedly asymmetric prostatic enlargement. Compared to bilateral PAE, IU-PAE was associated with significantly lower radiation exposure and a shorter procedure, but with no significant difference in clinical efficacy. Contrast-enhanced ultrasonography was applied during IU-PAE and revealed only limited prostatic infarction in the 2 clinical failures of IU-PAE, in contrast to the rest of the patients.