May 6, 2013

Course Of American Association Of Urology, Posters Presented:

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

Luis Campos Pinheiro*, Joao Pisco, Hugo Rio Tinto, Tiago Bilhim, Lucia Fernandes, Marisa Duarte, Jose´ Pereira, Antonio Gouveia Oliveira

2. 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

3. 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

April – NICE (National Institute for Health and Excellence)

Refers that PAE for BPH should only be used in the context of research, as we do.

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

2. Polyvinyl alcohol particle 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

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

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

Poster

SIR 2013 – Prostatic arterial embolization: can MR findings predict treatment outcome? Poster – Award

8

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

European Association of Urology Poster.

Eur. Urol Suppl 2013;12;e628
Clinical outcome of prostatic arterial embolization for patients with
benign prostatic hyperplasia and moderate to severe lower urinary tract
symptoms – 365 cases
Campos Pinheiro L.

1, Pisco J.2, Rio Tinto H.2, Bilhim T.2, Fernandes L.2, Duarte M.2, Preira J.2, Gouveia Oliveira

A.2

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.