Amy Robin Deipolyi MD, PhD, Presenter: Nothing to Disclose

Shehab A. Alansari MD, Abstract Co-Author: Nothing to Disclose

Shahin Tabatabaei MD, Abstract Co-Author: Education Advisory Board, Endo Health Solutions Inc Scientific Advisory Board, TARIS BioMedical, Inc

Suvranu Ganguli MD, Abstract Co-Author: Research Grant, Merit Medical Systems, Inc Consultant, Boston Scientific Corporation

Rahmi Oklu MD, PhD, Abstract Co-Author: Nothing to Disclose

Benign prostatic hyperplasia (BPH), widely prevalent in men over 50 years old, is associated with significant disability and healthcare cost. Prostate artery embolization (PAE) has been shown to be an effective interventional radiology treatment in other countries but is not approved in the US, limiting its study here. We evaluated the impact of internal iliac artery occlusion (IIAO) on prostate volume and urologic symptoms.

We reviewed 95 sequential male patients who underwent abdomen-pelvis CTA with runoff for evaluation of lower extremity claudication, including those 50 years of age and older and excluding those with prior prostate surgery, radiation or hormone therapy. We measured the diameter of both internal iliac origins and assessed for the presence of IIAO. Prostate volume was calculated from three diameters. Medical records were reviewed for PSA levels and urologic symptoms (i.e., hesitancy, frequency, urgency, nocturia) and symptoms of IIAO (buttock claudication, impotence). Statistical analyses included student’s t test, Fisher’s exact test and linear regression.

We included 77 men, 46 with patent internal iliac arteries and 31 men with either unilateral or bilateral occlusion. There was no difference in age between groups (mean 68 vs 64 years; p>0.1). However, men without IIAO had significantly larger prostates (mean 29cc, range 12–96cc), compared with men with IIAO (mean 19cc, range 8–67cc) (p=0.01). Prostate volume correlated with average internal iliac artery diameter (r2=0.2; p0.05). Men without IIAO were significantly more likely to have PSA levels assessed (66%) compared to men with IIAO (32%) (p=0.005). There was no significant difference in the number of men with impotence (8% vs 0; p>0.1) or with buttock claudication (17% vs 19%; p>0.1) in men without or with IIAO, respectively.

IIAO is associated with a 33% decrease in prostate volume and decreased urinary complaints, suggesting that PAE is likely an effective treatment for symptoms of BPH. Our findings furthermore suggest that unilateral and proximal arterial occlusion may be sufficient for therapeutic effect.

Internal iliac artery occlusion predicts reduced prostate volume, suggesting prostate artery embolization may be an effective interventional therapy for benign prostatic hyperplasia.

Deipolyi, A, Alansari, S, Tabatabaei, S, Ganguli, S, Oklu, R, Internal Iliac Artery Occlusion Decreases Prostate Volume and Urologic Symptoms: Evidence for Potential Efficacy of Prostate Artery Embolization?.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14011394.html