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Prostatic artery embolization

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Text of Prostatic artery embolization

  • Mohamed Shaker , MD MSIR , MCIRSE , MPAIRS Ass.Prof. of Interventional Radiology Ain Shams University Cairo-Egypt

  • Building PAE PracticeGEST 2012 , New York , USA

    Our team established in June 2012

  • Building PAE PracticeCo-operation with urologists

  • Building PAE Practice - Promoting for the technique in your IR clinic and /or establishing a clinic for PAE - Promotion through the media - Promotion through the internet Targeting the patient

  • Building PAE Practice Promoting for the technique in your IR clinic and /or establishing a clinic for PAE Targeting the patient

  • Building PAE Practice Promotion through the media Targeting the patient

  • Newspapers Articles

  • TV Medical shows

  • Building PAE Practice Promotion through the internet Targeting the patient

  • Facebook Page

  • Facebook Page

  • Web Sitewww.prostate-eg.com

  • Our ProtocolPelvic US with measurement of PVRUUrine analysis +/- urine culture and sensitivityPSA ; total and free/totalTRUS MRIUrine flowmetryIPSSQOLCBC , renal function tests , coagulation profile

  • Our TechniqueUrinary catheter Local anesthesiaUnilateral right femoral approachCatheterize Internal iliac arteries by a 5F Cobra or RUC catheterOblique view Catheterize anterior division.Rotational angiography with cone beam CT Prostatic arteries are selectively catheterized with a 2.7 fr. microcatheter ( Progreat ).Embolization using PVA particles 150 250 m.

  • Our Technique

  • ResultsWe performed 22 cases to dateAll cases were technically successful20 cases of bilateral embolization and 2 cases of unilateral embolizationWe have just finished our study including our first 14 cases with follow up at least for 6 months Rest of patients were done during last 6 months and are still under follow up .

  • Results

    Mean IPSS score before PAE was 24.7 and 6 months after PAE was 12.4 with significant P value of 0.0006 .

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    24.7142857143IPS preIPS pre

    12.4285714286IPSpostIPSpost

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    IPS pre24.7142857143

    IPSpost12.4285714286

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  • Results

    Mean prostatic volume before PAE by MRI was 84.6 and 6 months after PAE was 52 with mean volume reduction 38.6 %

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    84.6428571429MRI preMRI pre

    52.0714285714MRI.6MRI.6

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    MRI.652.0714285714

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  • Results

    Mean PVRU before PAE was 78.2 and 6 months after PAE was 8.6 with significant P value of 0.0007 .

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    78.2PVRU prePVRU pre

    29.1PVRU 1PVRU 1

    18.9PVRU 3PVRU 3

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    PVRU pre78.2

    PVRU 129.1

    PVRU 318.9

    PVRU68.6

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  • Results

    Mean Qmax before PAE was 12.2 and 6 months after PAE was 17 with significant P value of 0.0004 .

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    12.2727272727Qmax preQmax pre

    17.0909090909Qmax postQmax post

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    Qmax post17.0909090909

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  • ResultsNo major complication were recorded.Minor complication in the form of fungal cystitis took place in 1 patient (7.1%) and was successfully treated by antifungal drugs with suprapubic cystostomy.

  • Conclusion- PAE is a breakthrough interventional technique , suggested to be popular as UAE and may replace TURP. PAE is a feasible , safe , and highly effective technique ... Neverthless challenging .

    - We need to increase the number of IR doing this technique to make it more popular and increase the awareness of patients thus increasing the support in our battle with the urologists

  • THANK YOU

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