1. Prostate artery embolization (PAE) for bladder outflow obstruction: Results from the first UK prospective study Dyer J P, Bryant T, Coyne J, Flowers D, Somani B K, Harris M, Hacking N. University Hospital Southampton, Tremona Road, Southampton, SO16 6YD INCLUSION CRITERIAEXCLUSION CRITERIA Age >50 / <80Severe atherosclerosis / ectasia of iliac vessels on CTA Moderate / severe LUTS (IPSS >8, QOL ≥4) Surgical indications (bladder diverticulae, urethral stenosis, detrusor instability, neurogenic bladder) Peak urinary flow (Vmax) < 12ml/sProstate volume <40mls Medically refractory BPE > 6 monthsmalignancy (TRUS, MRI) Urodynamics – non-obstructive Abstract Introduction: Prostate artery embolisation (PAE) may offer men with bladder outflow obstruction (BOO) due to benign prostatic enlargement (BPE) an alternative to medical therapy or outflow surgery. Material and Methods: With ethical approval patients were assessed by International prostate symptom score (IPSS) and Quality of life (QoL), digital rectal examination, transrectal ultrasound, serum PSA, uroflowmetry and urodynamics. Patients with urodynamically proven outflow obstruction and prostate volume greater than 40cc proceeded to CT prostatic and pelvic angiography planning. Patients received PAE under local anaesthetic by femoral arterial access. Selective embolization was performed using hydrophillic microcatheters and polyvinyl alcohol (PVA) Results: PAE performed for 50 men, mean age 66 years (53-79 years). Results were compared at baseline and 3, 6 and 12 months post-PAE, with 100% technical success (at least unilateral embolization) and bilateral embolization in 80%. Mean IPSS improved from 24.7 (range: 24-35) to 12.4 (range: 1- 32) at 6 months. The mean QoL improved by 3 points from 5 (range:3-6) to 2 (range:2-5) with the baseline flow increasing from 7.4ml/sec (range:3-12) to 11.2ml/sec (range:3.6-24). Prostate volume reduction (45%) from 93cc (41-346) to 62cc (31-163). No major complications, retrograde ejaculation, erectile dysfunction or UTI. Minor complications included mild self- limiting suprapubic pain, transient haematospermia (1 patient) and small non-limiting arterial dissection (2 patients). Conclusions: PAE may offer an acceptable alternative to endoscopic prostate surgery in patients failing medical therapy with promising initial short-term results. However, appropriate patient selection and good technique is paramount for its success. MAJORMINOR NONESuprapubic/ perineal pain – 29/50 Non-limiting small arterial dissection - 2/50 Failure of angioseal closure device – 1/50 Urinary retention – 1 Transient haematospermia – 1 Patient Pathway Results: Patient reported outcome measures International prostate symptom score (IPSS) Quality of life (QOL) Prostate Volume reduction Results: Objective parameters International index of erectile function (IIEF) ≥2 QOL point improvement 1 QOL point improvement Worse/ no benefit 77% 14%9% Worse/ no benefit ≥25% improvement <25% improvement ≥50% improvement 59% 2% 21% 18% Worse/ no benefit 2% ≥50% improvement 59% 2% ≥50% improvement 59% <25% improvement 21% <25% improvement 21% ≥25% improvement 21% <25% improvement 21% 18% ≥25% improvement 59% 18% ≥25% improvement Worse/ no benefit 2% <25% improvement 21% 18% ≥25% improvement 35% 44% 21% 20-40% volume reduction <20% volume reduction >40% volume reduction Prostate Volume reductionFlow rate (ml/s) Conclusion Complications Prostate artery embolisation is a safe procedure with proven short term efficacy in men with proven bladder outflow obstruction. It offers men who are failing or are intolerant of medical therapy an alternative to TURP. It appears to be an attractive option for those patients where preservation of both ejaculatory and erectile function is important. In younger patients it may act as a bridge to TURP. Urodynamic pressure flow studies are important in the initial urological workup and long term efficacy remains to be tested. Treatment failures Technical success: 100% techinical success 80% bilateral embolisation 20% unilateral embolisation Clinical failures: 27 patients have >12 months follow up. After initial improvement 9 (33%) have failed to see a sustained benefit and are on the waiting list for TURP. P71