الفهرس 
THE PROSTATE GLANDOnly 14 pages are availabe for public view
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Abstract
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 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
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.