Mohamed Shaker , MD MSIR , MCIRSE , MPAIRS

Ass.Prof. of Interventional Radiology Ain Shams University

Cairo-Egypt

Building PAE PracticeBuilding PAE Practice GEST 2012 , New York , USAGEST 2012 , New York , USA

Our team established in June 2012Our team established in June 2012

Building PAE PracticeBuilding PAE Practice Co-operation with urologists Co-operation with urologists

Building PAE PracticeBuilding PAE Practice

- Promoting for the technique in your IR clinic and - Promoting for the technique in your IR clinic and

/or establishing a clinic for PAE/or establishing a clinic for PAE

- Promotion through the media - Promotion through the media

- Promotion through the internet- Promotion through the internet

Targeting the patient

Building PAE PracticeBuilding PAE Practice

Promoting for the technique in your IR Promoting for the technique in your IR

clinic and /or establishing a clinic for PAEclinic and /or establishing a clinic for PAE

Targeting the patient

Building PAE PracticeBuilding PAE Practice

Promotion through the media Promotion through the media

Targeting the patient

Newspapers Articles

TV Medical shows

Building PAE PracticeBuilding PAE Practice

Promotion through the internetPromotion through the internet

Targeting the patient

Facebook Page

Facebook Page

Web Sitewww.prostate-eg.com

Our ProtocolOur Protocol Pelvic US with measurement of PVRUPelvic US with measurement of PVRU Urine analysis +/- urine culture and sensitivityUrine analysis +/- urine culture and sensitivity PSA ; total and free/totalPSA ; total and free/total TRUS TRUS MRIMRI Urine flowmetryUrine flowmetry IPSSIPSS QOLQOL CBC , renal function tests , coagulation profileCBC , renal function tests , coagulation profile

Our TechniqueOur Technique Urinary catheter Urinary catheter Local anesthesiaLocal anesthesia Unilateral right femoral approachUnilateral right femoral approach Catheterize Internal iliac arteries by a 5F Cobra or RUC catheterCatheterize Internal iliac arteries by a 5F Cobra or RUC catheter Oblique view Oblique view Catheterize anterior division.Catheterize anterior division. Rotational angiography with cone beam CT Rotational angiography with cone beam CT Prostatic arteries are selectively catheterized with a 2.7 fr. Prostatic arteries are selectively catheterized with a 2.7 fr.

microcatheter ( Progreat ).microcatheter ( Progreat ). Embolization using PVA particles 150 – 250 μm.Embolization using PVA particles 150 – 250 μm.

Our TechniqueOur Technique

ResultsResults We performed 22 cases to dateWe performed 22 cases to date All cases were technically successfulAll cases were technically successful 20 cases of bilateral embolization and 2 cases of unilateral embolization20 cases of bilateral embolization and 2 cases of unilateral embolization We have just finished our study including our first 14 cases with follow up We have just finished our study including our first 14 cases with follow up

at least for 6 months at least for 6 months Rest of patients were done during last 6 months and are still under follow Rest of patients were done during last 6 months and are still under follow

up .up .

ResultsResults

- Mean IPSS score before PAE was 24.7 and 6 months after PAE was 12.4 with

significant P value of 0.0006 .

ResultsResults

- Mean prostatic volume before PAE by MRI was 84.6 and 6 months after PAE

was 52 with mean volume reduction 38.6 %

ResultsResults

- Mean PVRU before PAE was 78.2 and 6 months after PAE was 8.6 with

significant P value of 0.0007 .

ResultsResults

- Mean Qmax before PAE was 12.2 and 6 months after PAE was 17 with

significant P value of 0.0004 .

ResultsResults

No major complication were recorded.No major complication were recorded.

Minor complication in the form of fungal cystitis took Minor complication in the form of fungal cystitis took

place in 1 patient (7.1%) and was successfully treated place in 1 patient (7.1%) and was successfully treated

by antifungal drugs with suprapubic cystostomy.by antifungal drugs with suprapubic cystostomy.

ConclusionConclusion- 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