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Thursday, September 13, 2018

Prostatic Artery Embolization with 250-μm Spherical Polyzene-Coated Hydrogel Microspheres for Lower Urinary Tract Symptoms with Follow-up MR Imaging


Summary


Investigators from the University of Jena, Germany, published their initial experience of prostatic artery embolization (PAE) with 250-μm spherical, Polyzene-coated hydrogel microspheres with a diameter of 250 μm (Embozene; Boston Scientific). 30 patients with moderate to severe lower urinary tract symptoms were included in this prospective, nonrandomized study. Clinical outcomes and possible MR imaging predictors of clinical success were analyzed. PAE was technically successful in 90% of patients (who had at least unilateral embolization). Clinical success measured by decreased IPSS and QOL scores and increased Qmax were accomplished in 59% (16 of 27), 63% (17 of 27), and 74% (20 of 27) after 1, 3, and 6 mo, respectively. IIEF scores did not differ significantly during follow-up. Adverse events included urethral burning (5 of 27), fever (2 of 27), and urethral bleeding, rectal bleeding, cystitis, and penile burning sensation (1 of 27 each). No initial MR imaging changes correlated statistically with clinical outcomes after 6 months (P values from .14 to .98). The authors concluded that PAE with 250-μm hydrogel microspheres led to good clinical success after 6 months with a low complication rate and MR imaging predictors of clinical success were not identified.



Figure. (a) Posterior–anterior view of the left hemiprostate after application of contrast material. The microcatheter is placed above the bifurcation of the left prostatic artery into a central branch (vertical arrow) and a lateral branch (horizontal arrow). (b) Image after PAE with 250-μm microspheres.

Commentary


This manuscript presents the results of a specific embolic agent, 250um Polyzene-coated hydrogel microspheres (Embozene; Boston Scientific), on PAE performed in a limited cohort of patients with symptomatic BPH. Effectiveness and safety results were comparable to the current literature. As PAE is becoming a common therapeutic approach in this patient population, the question of which embolic agent is the most appropriate starts to emerge. Recent meta-analysis including studies that used different types of particulate agents showed better clinical outcomes with smaller PVA (50-100um). However, to better answer this question large randomized control trials would be required. For now any additional evidence on different agents are welcomed to help interventionalists decide which material to use. Finally, defining predictor factors for better clinical outcomes on imaging can be extremely helpful, but this was not possible in the present study likely due to the small sample size, which is a limitation. Further investigation could aim to define predictor factors on pre-procedure imaging. These potential findings could really impact the decision making process and clinical management.

Click here for abstract

Franiel T, Aschenbach R, Trupp S, et al. Prostatic artery embolization with 250-μm spherical polyzene-coated hydrogel microspheres for lower urinary tract symptoms with follow-up MR imaging. J Vasc Interv Radiol. 2018; 29: 1127-1137.

Post Author:
Ricardo Yamada, MD
Assistant Professor
Department of Radiology
Division of Vascular and Interventional Radiology
Medical University of South Carolina

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