prostate arterial embolization in benign prostate hyperplasia...potential conflicts of interest...

Prostate arterial embolizationin benign prostate hyperplasia

Disclosure

Speaker name: Ulf Teichgräber, MD, MBA

Potential conflicts of interest related to the presentation:

o Research grant, honoraria: Boston Scientific

Potential conflicts of interest not related to the presentation:

o Consulting Fees, Honoraria, Research Grants, Advisory Boards: ab medica, Abbott, Angiodroid, Vascular, B.Braun Melsungen, Boston Scientific (Celonova), C.R. Bard, COOK, Endoscout, GE Healthcare, iVascular, Kimal, Maquet, Medtronic, Philips Healthcare, Siemens Heathcare, Spectranetics, W.L.Gore

o Master research agreements with Siemens Healthcare, GE Healthcare

BPH

• Transuethral resection of the prostate (TURP) isstill considered the standard surgical therapyfor the treatment of non-neurogenic male lower urinary tract symptoms (LUTS)

• A retrograde ejaculation, and sexual dysfunction are typical side effects of TURP

• Minimally invasive methods such as PAE arearising with the intention to provide fewercomplications

Pelvic vessels

4

Quelle: Netter

6

Typical anatomy?

1. Iliolumbar artery

2. Sacral internal artery

3. Superior gluteal artery

4. Inferior gluteal artery

5. Obturator artery

6. Umbilical artery

7. Superior vesical artery

8. Inferior vesical artery

9. Prostate artery

10.Medial rectal artery

11.Internal pudendal artery

7

Anatomische Varianten

Prof. Dr. Herbert Lippert, Urban&Schwarzenberg 1968

Leipzig, 06.05.16 8

1) Commen trunk of superior vesical a. +

inferior vesical a.

2) Obturator a.

3) Prostate a.

4) Internal pudendal a.

5) Inferior gluteal a.

9

Uncommon origin of the

prostate a. out of superior

gluteal artery

Technique

10Image source: www.competence-site.de

Material

11

Material / Vorgehen

1. Access groin (4F sheath)

2. Acccess the contralateral internal iliac a. with a 4 F selektiv catheter(e.g. RIM Tempo, Cordis)

3. Advancing a mircrocatheter into the prostate a. (e.g. Progreat α 2.0 F, Terumo)

4. First embolisation with microspheres (e.g. Embozene 250 µm)

5. Access the der ipsilateral prostate a.

6. Second embolisation

Ajustment of the angiography

• Before embolisation: confirmation in two plains

• 1. a.p. projection

• 2. LAO/RAO 30°(ggf. 10° cc angulation)

12

13

Prostata Arterienembolisation - Prof. Dr. U. Teichgräber

14Berlin, 14.01.17

15

Challange

16

17

180ml(76 x 58 x 78mm x π/6)

142ml(72 x 51 x 74mm x π/6)

- 21%

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19

Radiology: Volume 270: Number 3—March 2014

Postinterventional Symptoms

20

Gao Y, Huang Y, Zhang R et al. Radiology 2014; 270(3):920-928

21Gao Y, Huang Y, Zhang R et al. Radiology 2014; 270(3):920-928

Kurbatov D, et al. Urology 2014; 84: 400-404

•88 patients (IPSS ≥ 12, PV ≥ 80cm3, Qmax < 15ml/s)

BPH & Prostate gland > 80g

Own results

24

Conclusions

• Anatomic variations

(+arteriosclerosis)

• Risk of inadvertent

embolization of the rectum or

• Low acceptance of urologists

• No trauma to the urethra

• Alternative to TURP especially in

Prostate gland vol. >65 ml

• Alternative in patients at risk

(coagulopathy, general anesthesia)

PROS CONS

Prostate arterial embolizationin benign prostate hyperplasia