Lower Urinary Tract Symptoms in Adults by Marcus Drake & Andrea Cocci & Ricardo Pereira e Silva

Author:Marcus Drake & Andrea Cocci & Ricardo Pereira e Silva
Language: eng
Format: epub
ISBN: 9783030277475
Publisher: Springer International Publishing

5.6.5 Prostatic Artery Embolization—PAE

Prostatic artery embolization (PAE) can be undertaken with digital subtraction angiography displaying the arteria l sup ply of the prostate. The relevant vessels are selectively embolized to aim for atrophy in the vascular distribution. It is performed as a day case procedure under local anesthesia, but it can be time-consuming and uncomfortable, as a result of atherosclerosis, tortuosity, and the presence of collateral vessels. It is an interventional radiology procedure which is technically demanding. Initial nonrandomized trials demonstrated efficacy of PAE up to 12 months. Two prospective studies were conducted comparing PAE with TURP or open prostatectomy; resection and open prostatectomy both fared better regarding improvement of LUTS and reduction of prostate volume, but PAE did achieve benefits. A systematic review found that PAE is less effective and currently remains in development. Occasional serious complications have arisen, including non-target embolization, for example, affecting the bladder. PAE has more adverse events than prostatectomy (42% vs. 30%), including a higher rate of acute urinary retention.

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