الفهرس | Only 14 pages are availabe for public view |
Abstract Summary BPH refers to the increase in size of the prostate in middle aged and elderly men. The normal prostate is composed of a combination of glandular, stromal, and smooth muscle cells. BPH is due to a proliferation of glandular elements, fibromuscular (stromal) elements, or both, resulting in the formation of large, fairly discrete nodules in the periurethral region of the prostate. Symptomatic BPH typically occurs in the sixth and seventh decades, and more than 40% of men older than this present with clinical manifestations of this disease. The most frequent obstructive urinary symptoms are hesitancy, decreased urinary stream, intermittency, sensation of incomplete emptying, nocturia, frequency, urgency and sometime urinary retention, which severely affect the patients’ quality of life. The standard management of BPH is based on the overall health of the patient and the severity of symptoms. Medications, specifically 5-alpha-reductase inhibitors and selective alpha blockers, can decrease the severity of voiding symptoms secondary to BPH. Even with the development of new therapies, prostatectomy accomplished by transurethral or open surgical means constitutes the traditional surgical treatment for BPH, but considering the comorbidities , prostatectomy in this age group is considered to be high-risk. PAE has been used successfully, mainly to control massive hemorrhage after prostatectomy or prostate biopsy. Recently, studies showed that PAE could be performed safely, with a significant reduction of prostate volume, without compromising the sexual function and erectile function. PAE Summary and Conclusion 64 could be used as an alternative treatment, with the aim of reducing the prostate size and producing relief from symptoms caused by BPH. Most authors recommend the use of PAE in patients with the following criteria: Total score of IPSS is > 18 and if QoL > 4 or if they are in acute urinary retention with bladder catheter with prostate volume more than 40 cc & refractory to medical therapy, for at least 6 months with moderate to severe lower urinary tract symptoms. Also patients with peak urinary flow rate (Qmax) inferior to 12 mL/s or with acute urinary retention. (Pisco, 2012). Malignancy, Advanced atherosclerosis, Bladder stone or diverticulae & Marked tortuosity of the iliac arteries are absolute contraindications to the procedure. (Pisco, 2012). Prior to PAE, CT or MR angiography is used to evaluate the pelvic vessels for tortuosity and atherosclerotic changes of the iliac arteries so show the possibility of embolizing prostatic blood vessels, the prostate volume is also measured by MRI. Complications were categorized as complications of angiography (related to puncture site, contrast agents, or radiation injury), pelvic infection, ischemic complications, sexual dysfunction, adverse drug reactions, and other. Many studies done to evaluate whether prostatic arterial embolization (PAE) might be a feasible procedure to treat lower urinary tract symptoms associated with benign prostatic Summary and Conclusion 65 hyperplasia (BPH) and the results was: despite the withdrawal of all prostatic medications after PAE, there was a significant improvement of the IPSS, QOL improved, The sexual function improved in some patients and remained stable in others. The benefits of PAE compared with other invasive treatments are that PAE is minimally invasive, performed under local anesthesia and can be done as an outpatient procedure. Lower urinary tract symptoms can be controlled even in patients at the end stage of the disease with acute urinary retention. Prostatic artery embolization does not manipulate the urethra, avoiding urethral stenosis, and can be performed even in large prostates and in patients with urinary retention. Conclusion PAE in patients with symptomatic BPH is safe, with low morbidity, good short and medium term results. PAE is still a new technique that needs to be tested by other studies and researches to evaluate its role as a long term treatment, possible long term complications if found and to compare its results, advantages and complications with the corresponding results of the standard surgical treatment both transurethral and open prostatectomy. |