Benign Prostatic Hyperplasia: Transcatheter Arterial Embolization as Potential Treatment—Preliminary Study in Pigs

Purpose: To prospectively evaluate the technical feasibility and safety of transcatheter arterial embolization (TAE) of the prostate in healthy pigs.

Materials and Methods: The study was approved by the institutional ethics committee for animal research. Sixteen large white male pigs were randomly assigned to the embolization group (n = 8) or control group (n = 8). Selective angiography was performed in all animals after general anesthesia was induced. In the embolization group, microspheres 500–700 μm in diameter were used to occlude the prostatic branches. Three months later, the animals' sexual function while breeding with female pigs was subjectively evaluated by using a three-point scale. At necropsy, the prostates were removed for size measurement and histopathologic examination. Paired Student t and Wilcoxon rank sum tests were used for statistical analysis.

Results: TAE was technically successful in all animals, without associated complications. The mean prostate volume after embolization was significantly (P < .001) reduced compared with the mean prostate volume for the group control. No significant difference (P = .328) in sexual function was noted between the two groups. Histologic examination revealed that the microspheres had occluded the arterioles of the prostate, with disappearance of the nearby partially normal gland structure and atrophy of the residual gland tissue.

Conclusion: TAE of the prostate can induce shrinkage of the prostate without compromising the sexual desire and erectile function of animals. This finding suggests that TAE has potential as an alternative treatment for symptomatic benign prostatic hyperplasia in humans.

© RSNA, 2008

References

  • 1 Guess HA, Arrighi HM, Metter EJ, Fozard JL. Cumulative prevalence of prostatism matches the autopsy prevalence of benign prostatic hyperplasia. Prostate 1990; 17(3): 241–246. Crossref, MedlineGoogle Scholar
  • 2 Chute CG, Panser LA, Girman CJ, et al. The prevalence of prostatism: a population-based survey of urinary symptoms. J Urol 1993;150(1):85–89. Crossref, MedlineGoogle Scholar
  • 3 Wei JT, Calhoun E, Jacobsen SJ. Urologic diseases in America project: benign prostatic hyperplasia. J Urol 2005;173(4):1256–1261. Crossref, MedlineGoogle Scholar
  • 4 Roehrborn CG, Preminger G, Newhall P, et al. Microwave thermotherapy for benign prostatic hyperplasia with the Dornier urowave: results of a randomized, double-blind, multicenter, sham-controlled trial. Urology 1998;51(1):19–28. CrossrefGoogle Scholar
  • 5 Wheelahan J, Scott NA, Cartmill R, et al. Minimally invasive laser techniques for prostatectomy: a systematic review. BJU Int 2000;86(7):805–815. MedlineGoogle Scholar
  • 6 Roehrborn CG, Issa MM, Bruskewitz RC, et al. Transurethral needle ablation for benign prostatic hyperplasia: 12-month results of a prospective, multicenter U.S. study. Urology 1998;51(3):415–421. Crossref, MedlineGoogle Scholar
  • 7 Cioanta I, Muschter R. Water-induced thermotherapy for benign prostatic hyperplasia. Tech Urol 2000;6(4):294–299. MedlineGoogle Scholar
  • 8 Appleton DS, Sibley GN, Doyle PT. Internal iliac artery embolisation for the control of severe bladder and prostate haemorrhage. Br J Urol 1988;61(1):45–47. Crossref, MedlineGoogle Scholar
  • 9 Vallina Vazquez MJ, Gutierrez Julian JM, Vega Gutierrez F, et al. Hematoma perineal pulsátil tras biopsia prostática transrectal. Arch Esp Urol 1999;52(9):998–1002. MedlineGoogle Scholar
  • 10 DeMeritt JS, Elmasri FF, Esposito MP, Rosenberg GS. Relief of benign prostatic hyperplasia-related bladder outlet obstruction after transarterial polyvinyl alcohol prostate embolization. J Vasc Interv Radiol 2000;11(6):767–770. Crossref, MedlineGoogle Scholar
  • 11 Barbieri A, Simonazzi M, Marcato C, et al. Massive hematuria after transurethral resection of the prostate: management by intra-arterial embolization. Urol Int 2002;69(4):318–320. Crossref, MedlineGoogle Scholar
  • 12 Michel F, Dubruille T, Cercueil JP, Paparel P, Cognet F, Krause D. Arterial embolization for massive hematuria following transurethral prostatectomy. J Urol 2002;168(6):2550–2551. Crossref, MedlineGoogle Scholar
  • 13 Ziada A, Rosenblum M, Crawford ED. Benign prostatic hyperplasia: an overview. Urology 1999;53(3 suppl 3a):1–6. MedlineGoogle Scholar
  • 14 Roehrborn CG. Benign prostatic hyperplasia: an overview. Rev Urol 2005;7(suppl 9):S3–S14. Google Scholar
  • 15 Caine M, Raz S, Zeigler M. Adrenergic and cholinergic receptors in the human prostate, prostatic capsule and bladder neck. Br J Urol 1975;47(2):193–202. Crossref, MedlineGoogle Scholar
  • 16 Lepor H, Shapiro E. Characterization of alpha1 adrenergic receptors in human benign prostatic hyperplasia. J Urol 1984;132(6):1226–1229. Crossref, MedlineGoogle Scholar
  • 17 Pinto I, Chimeno P, Romo A, et al. Uterine fibroids: uterine artery embolization versus abdominal hysterectomy for treatment—a prospective, randomized, and controlled clinical trial. Radiology 2003;226(2):425–431. Google Scholar
  • 18 Pelage JP, Le Dref O, Soyer P, et al. Fibroid-related menorrhagia: treatment with superselective embolization of the uterine arteries and midterm follow-up. Radiology 2000;215(2):428–431. LinkGoogle Scholar
  • 19 Lekas E, Johansson M, Widmark A, Bergh A, Damber JE. Decrement of blood flow precedes the involution of the ventral prostate in the rat after castration. Urol Res 1997;25(5):309–314. Crossref, MedlineGoogle Scholar
  • 20 Shabsigh A, Chang DT, Heitjan DF, et al. Rapid reduction in blood flow to the rat ventral prostate gland after castration: preliminary evidence that androgens influence prostate size by regulating blood flow to the prostate gland and prostatic endothelial cell survival. Prostate 1998;36(3):201–206. Crossref, MedlineGoogle Scholar
  • 21 Franck-Lissbrant I, Häggström S, Damber JE, Bergh A. Testosterone stimulates angiogenesis and vascular regrowth in the ventral prostate in castrated adult rats. Endocrinology 1998;139(2):451–456. Crossref, MedlineGoogle Scholar
  • 22 Lv HQ, Gao YA, Cheng GL, Yang YD, Yan HL. Preliminary study of artery embolization in the treatment of benign prostatic hyperplasia. Chin J Urol 2005;26(12):823–825. Google Scholar
  • 23 Bdesha AS, Schachter M, Sever P, Witherow RO. Radioligand-binding analysis of human prostatic alpha-1 adrenoreceptor density following transurethral microwave therapy. Br J Urol 1996;78(6):886–892. Crossref, MedlineGoogle Scholar
  • 24 Brehmer M. Morphological changes in prostatic adenomas after transurethral microwave thermotherapy. Br J Urol 1997;80(1):123–127. Crossref, MedlineGoogle Scholar
  • 25 Zlotta AR, Raviv G, Peny MO, Noel JC, Haot J, Schulman CC. Possible mechanisms of action of transurethral needle ablation of the prostate on benign prostatic hyperplasia symptoms: a neurohistochemical study. J Urol 1997;157(3):894–899. Crossref, MedlineGoogle Scholar
  • 26 Pisco JM, Martins JM, Correia MG. Internal iliac artery: embolization to control hemorrhage from pelvic neoplasms. Radiology 1989;172(2):337–339. LinkGoogle Scholar
  • 27 Hietala SO. Urinary bladder necrosis following selective embolization of the internal iliac artery. Acta Radiol Diagn (Stockh) 1978;19(2):316–320. Crossref, MedlineGoogle Scholar
  • 28 Carmignani G, Belgrano E, Puppo P, Cichero A, Giuliani L. Transcatheter embilization of the hypogastric arteries in cases of bladder hemorrhage from advanced pelvic cancers: followup in 9 cases. J Urol 1980;124(2):196–200. Crossref, MedlineGoogle Scholar
  • 29 Hare WS, Holland CJ. Paresis following internal iliac artery embolization. Radiology 1983;146(1):47–51. LinkGoogle Scholar
  • 30 AUA Practice Guidelines Committee. AUA guideline on management of benign prostatic hyperplasia, 2003. I. Diagnosis and treatment recommendations. J Urol 2003;170(2 pt 1):530–547. Crossref, MedlineGoogle Scholar
  • 31 Pearlman CK, Kobashi LI. Frequency of intercourse in men. J Urol 1972;107(2):298–301. Crossref, MedlineGoogle Scholar
  • 32 Rosen R, Altwein J, Boyle P, et al. Lower urinary tract symptoms and male sexual dysfunction: the multinational survey of the aging male (MSAM-7). Eur Urol 2003;44(6):637–649. Crossref, MedlineGoogle Scholar
  • 33 Feldman HA, Goldstein I, Hatzichristou DG, Krane RJ, McKinlay JB. Impotence and its medical and psychosocial correlates: results of the Massachusetts Male Aging Study. J Urol 1994;151(1):54–61. Crossref, MedlineGoogle Scholar
  • 34 McVary K. Lower urinary tract symptoms and sexual dysfunction: epidemiology and pathophysiology. BJU Int 2006;97(suppl 2):23–28. MedlineGoogle Scholar
  • 35 Malone PR, Cook A, Edmonson R, Gill MW, Shearer RJ. Prostatectomy: patients' perception and long-term follow-up. Br J Urol 1988;61(3):234–238. Crossref, MedlineGoogle Scholar
  • 36 Arai Y, Aoki Y, Okubo K, et al. Impact of interventional therapy for benign prostatic hyperplasia on quality of life and sexual function: a prospective study. J Urol 2000;164(4):1206–1211. Crossref, MedlineGoogle Scholar
  • 37 Giuliano F. Impact of medical treatments for benign prostatic hyperplasia on sexual function. BJU Int 2006;97(suppl 2):34–38. Crossref, MedlineGoogle Scholar
  • 38 Rittmaster RS. Finasteride. N Engl J Med 1994;330(2):120–125. Crossref, MedlineGoogle Scholar
  • 39 Poulakis V, Ferakis N, Witzsch U, de Vries R, Becht E. Erectile dysfunction after transurethral prostatectomy for lower urinary tract symptoms: results from a center with over 500 patients. Asian J Androl 2006;8(1):69–74. Crossref, MedlineGoogle Scholar
  • 40 Hegarty PK, Hegarty NJ, Fitzpatrick JM. Sexual function in patients with benign prostatic hyperplasia. Curr Urol Rep 2001;2(4):292–296. Crossref, MedlineGoogle Scholar

Article History

Published in print: 2008