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Predictability and Inducibility of Detachment of Prostatic Central Gland Tissue after Prostatic Artery Embolization: Post Hoc Analysis of a Randomized Controlled Trial

Lukas Hechelhammer, Gautier Müllhaupt, Livio Mordasini, Stefan Markart, Sabine Güsewell, Patrick Betschart, Hans-Peter Schmid, Daniel S Engeler & Dominik Abt

abstract

PURPOSE
To assess the frequency and potential predictors of prostatic central gland tissue detachment (CGD), an enucleation-like reaction that sporadically occurred in a randomized controlled trial assessing efficacy and safety of prostatic artery embolization (PAE).

MATERIALS AND METHODS
Trial data were analyzed to identify patients with CGD after PAE. Clinical parameters, MR imaging findings, technical details of PAE, and periinterventional data were compared between patients with and without CGD to identify parameters for prediction, induction, or early detection of CGD after PAE.

RESULTS
CGD occurred after PAE in 3 of 48 patients (6.3%); these cases had good functional outcomes, but CGD was associated with increased risk of ejaculatory dysfunction and occurrence of complications. Frequency of preoperative transurethral bladder catheterization (100% vs 13.3%; P = .005), central gland index (mean ± standard deviation, 0.86 ± 0.02 vs 0.69 ± 0.14; P < .001), amount of particles applied (1.93 mL ± 0.12 vs 0.96 mL ± 0.36; P < .001), maximum early postoperative pain score (7.33 ± 2.08 vs 1.89 ± 2.40; P = .009), and blood C-reactive protein (CRP) levels after 48 hours (69.0 vs 18.58 mg/dL; P = .045) and 1 week (113.50 vs 5.16 mg/dL; P = .004) were significantly higher in cases of CGD.

CONCLUSIONS
CGD is a rare reaction that might be triggered by prostatic zonal anatomy, embolization technique, and mechanical or inflammatory processes. It should be considered in patients with severe postoperative pain and high CRP levels who experience voiding dysfunction after PAE to avoid complications. Investigation of larger cohorts might further elucidate this tissue response.
   
citation Hechelhammer L, Müllhaupt G, Mordasini L, Markart S, Güsewell S, Betschart P, Schmid H P, Engeler D S, Abt D. Predictability and Inducibility of Detachment of Prostatic Central Gland Tissue after Prostatic Artery Embolization: Post Hoc Analysis of a Randomized Controlled Trial. J Vasc Interv Radiol 2019; 30:217-224.
   
type journal paper/review (English)
date of publishing 17-01-2019
journal title J Vasc Interv Radiol (30/2)
ISSN electronic 1535-7732
pages 217-224
PubMed 30661948
DOI 10.1016/j.jvir.2018.09.029