EMBOLIZATION OF PROSTATIC ARTERIES AS A METHOD TO RESTORE URINATION IN BENIGN PROSTATIC HYPERPLASIA AND SUPRAPUBIC URINARY DRAINAGE

Prostatic artery embolization (PAE) is an X-ray endovascular method for treating lower urinary tract symptoms. The use of PAE in patients with suprapubic urinary diversion in order to restore natural urination has not been described in the domestic literature, and in foreign literature there are only few publications based on small clinical material.

The purpose of the study was to evaluate the effectiveness of prostatic artery embolization to restore natural urination in patients with suprapubic urinary diversion performed for acute urinary retention due to benign prostatic hyperplasia.

Material and methods. From March 2021 to November 2023, PAE was performed in 10 patients with suprapubic urinary diversion. Efficacy was assessed at 4–6 weeks, 6 and 12 months after embolization. The average age was 68.5±7.1 years old, the average prostate volume was 153±68.1 cm³.

Results. All patients underwent PAE on both sides. No intra- or postoperative complications were observed. In 7 (70%) patients, natural urination restored after 4-6 weeks: Qmax 10.8±3 ml/s, and residual urine volume – 29±22 ml. After 12 months, no one reported worsening urination: Qmax – 12.0±1.6 ml/s.

1. Dougherty JM, Aeddula NR. Male Urinary Retention. 2022 Aug 10. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2023 Jan–. PMID: 30860734. (in Engl)

2. Serlin DC, Heidelbaugh JJ, Stoffel JT. Urinary Retention in Adults: Evaluation and Initial Management. Am Fam Physician. 2018 Oct 15;98(8):496-503. (in Engl)

3. Billet M, Windsor TA. Urinary Retention. Emerg Med Clin North Am. 2019 Nov;37(4):649-660. (in Engl)

4. Gelber J, Singh A. Management of acute urinary retention in the emergency department. Emerg Med Pract. 2021 Mar;23(3):1-28. (in Engl)

5. Sandhu JS, Bixler BR, Dahm P, et al. Management of lower urinary tract symptoms attributed to benign prostatic hyperplasia (BPH): AUA Guideline amendment 2023. J Urol. 2023. https://doi.org/10.1097/JU.0000000000003698 (in Engl)

6. Teodorovich O.V., Davlatbiev S.A. Complication of transurethral resection of the prostate (case report). Bulletin of new medical technologies. Electronic edition. 2017;1. URL: https://cyberleninka.ru/article/n/oslozhnenie-transuretralnoy-rezektsii-predstatelnoy-zhelezysluchay-iz-praktiki (date of access: 05.22.2024). (in Russ)

7. Camara-Lopes, G. [et al.] The histology of prostate tissue following prostatic artery embolization for the treatment of benign prostatic hyperplasia. Int. Braz. J. Urol. 2013;39(2):222-227 DOI: 10.1590/S1677-5538.IBJU.2013.02.11 (in Engl)

8. Carnevale FC, da Motta-Leal-Filho JM, Antunes AA, Baroni RH, Marcelino AS, Cerri LM, Yoshinaga EM, Cerri GG, Srougi M. Quality of life and clinical symptom improvement support prostatic artery embolization for patients with acute urinary retention caused by benign prostatic hyperplasia. J Vasc Interv Radiol. 2013 Apr;24(4):535-42. doi: 10.1016/j.jvir.2012.12.019. (in Engl)

9. Yu SC, Cho CC, Hung EH, Chiu PK, Yee CH, Ng CF. Prostate Artery Embolization for Complete Urinary Outflow Obstruction Due to Benign Prostatic Hypertrophy. Cardiovasc Intervent Radiol. 2017 Jan;40(1):33-40. doi: 10.1007/s00270-016-1502-3. (in Engl)

10. Kenny AG, Pellerin O, Amouyal G, Desgranchamps F, Méria P, De Gouvello A, Dariane C, Déan C, Pereira H, Thiounn N, Sapoval M. Prostate Artery Embolization in Patients With Acute Urinary Retention. Am J Med. 2019 Nov;132(11):e786-e790. (in Engl)

11. Leng B, Zhou CG, Liu S, Xu ZW, Tian W, Shi HB. Prostatic Artery Embolization to Achieve Freedom from Catheterization in Patients with Acute Urinary Retention Caused by Benign Prostatic Hyperplasia. J Vasc Interv Radiol. 2021 Jul;32(7):1062-1067. doi: 10.1016/j.jvir.2021.03.530. (in Engl)

12. Marchi A, Pellerin O, Querub C, Ahmar MA, Gaeta AD, Déan C, Meria P, Thiounn N, Sapoval M, Boeken T. Long-term outcomes of prostate artery embolization for acute urinary retention: An analysis of 88 patients. Diagn Interv Imaging. 2023 Jun;104(6):292-296. doi: 10.1016/j.diii.2023.01.012. (in Engl)

13. Tang Y, Zhang JH, Zhu YB, Wu SJ, Cai SL, Zhou YF, Qian X, Luo JW, Fang ZT. Effect of superselective prostatic artery embolization on benign prostatic hyperplasia. Abdom Radiol (NY). 2021 Apr;46(4):1726-1736. doi: 10.1007/s00261-020-02782-2. (in Engl)

14. Hamed Ibrahim W, Abduljawad H, Mohamed H, Jamsheer N, Elsayed Elnaggar M. Prostatic Artery Embolization for the Treatment of Benign Prostate Hyperplasia: Initial Experience From Bahrain. Cureus. 2022 Feb 25;14(2):e22593. doi: 10.7759/cureus.22593. (in Engl)

15. Xu ZW, Zhou CG, Tian W, Shi HB, Liu S. Long-Term Efficacy and Recurrence Prediction of Prostatic Artery Embolization for Lower Urinary Tract Symptoms Secondary to Benign Prostatic Hyperplasia. Cardiovasc Intervent Radiol. 2022 Dec;45(12):1801-1809. (in Engl)