Prostatic artery embolization for benign prostatic hyperplasia during the COVID pandemic. A countermeasure to prostatic surgery cancellations

ABSTRACT

Purpose: To describe the utilization and role of prostatic artery embolization (PAE) for symptomatic benign prostatic hyperplasia (BPH) during the COVID pandemic in a single tertiary center. Material(s) and Method(s) From March 2020 to November 2021, 105 patients with symptomatic BPH, were referred for evaluation for PAE as a result of cancellation of their scheduled surgery (transurethral resection or open prostatectomy) due to the COVID pandemic. The usual selection criteria for PAE were applied. Patients with indwelling bladder catheter (IBC) and severe lower urinary tract symptoms (LUTS) were given priority over patients with moderate LUTS. For PAE, vascular access was gained via the femoral (4 French sheath) or left radial artery and PA was catheterized with a microcatheter (<=2.0 French). Embolization was performed with microspheres (100-300 and/or 300-500 microns, Embosphere, Merit Medical). Definition of clinical success was based on reduction of International Prostate Symptom Score (IPSS) of at least 25% from the baseline, or successful removal of IBC. Result(s) 65 patients (mean age 71.5 years, mean prostatic volume 90.6ml) eventually underwent PAE during the study period (IBC/severe LUTS 31/34;unilateral/bilateral PAE 14/51;radial/femoral access 12/53 patients). All patients were discharged 3-10 hours post PAE. Clinical success rates were 98.5%, 90.2%, 80.2% and 80.2% at 3, 6, 12 and 18 months post PAE, respectively. Mean IPSS improvement was 52.8%. Complications (only minor 12/65 patients) were managed on outpatient basis. Conclusion(s) During the COVID pandemic, PAE proved to be an effective countermeasure to prostatic surgery cancellations.