攝護腺動脈栓塞術於攝護腺肥大病患之治療經驗分享及文獻回顧
謝享宸、裘坤元、王賢祥、陳正哲
臺中榮民總醫院 外科部 泌尿外科
Prostate artery embolization for benign prostatic hyperplasia:
experience and literature review
Hsiang-Chen Hsieh, Kun-Yuan Chiu, Shian-Shiang Wang, Cheng-Che Chen
Divisions of Urology, Department of Surgery, Taichung Veterans General Hospital, Taiwan
Introduction: Benign prostatic hyperplasia (BPH) is a common clinical condition in middle-aged (50% of men aged 60-69 years) and elderly men (90% of men aged 70–89 years) resulting in lower urinary tract symptoms (LUTS), including nocturia, urinary frequency, urgency, decreased urinary flow rates, hesitancy, and incomplete bladder emptying. Medical therapy is usually the first-line treatment. However, in cases with moderate to severe lower urinary tract symptoms, transurethral resection of the prostate (TURP) is the gold standard of surgical treatment. Recently, prostatic artery embolization (PAE) was described as a novel effective and minimal invasive treatment alternative. There are three cases as our experience with literature review.
Experience and Cases: We reported three cases of successful PAE as a treatment for LUTS related to BPH. Two patients were embolized with 300- to 500-lm microspheres alone and one with 250-lm microspheres. Obliterating blood flow of bilateral prostatic arteries was done in two patient, and left prostatic artery only in one. During follow-up, the three patients all presented with significant improvements in LUTS and urodynamic parameters in one patient was observed.
Discussion: TURP is limited to prostates smaller than 60-80 ml and the procedure is associated with a substantial complication rate. The cumulative short-term morbidity rate is around 11% and the necessity for surgical revision is as high as 6%. PAE is a minimally invasive alternative treatment, which has the advantage of being an outpatient procedure that requires only local anesthesia or moderate sedation with rapid recovery and low morbidity. Although there are multiple studies demonstrating PAE is safe and effective in reducing LUTS, the amount of Randomized Controlled Trial (RCT) data are limited. Future study designs should include multicenter, prospective RCTs for comparing PAE and other BPH therapies with multiple-year follow-up.
Conclusion: Our cases presented improved LUTS after PAE when follow-up. Based on the current available data in multiple studies, PAE appears to be an effective and safe minimally invasive technique to treat LUTS resulting from BPH.