Intra-vesical Prostatic Protrusion (IPP) Can Be Reduced by Prostatic Artery Embolization

Area of Science:

• Interventional Radiology
• Urology
• Medical Imaging

Background:

• Prostate artery embolization (PAE) is an emerging treatment for benign prostatic hyperplasia (BPH)-related lower urinary tract symptoms (LUTS).
• PAE is known to reduce overall prostate volume (PV).
• The effect of PAE on intra-vesical prostatic protrusion (IPP), a key factor in bladder outlet obstruction, remains uninvestigated.

Purpose of the Study:

• To evaluate the efficacy of PAE in reducing significant IPP caused by median lobe hyperplasia.
• To compare the reduction in IPP with the improvement in LUTS, specifically International Prostate Symptom Score (IPSS).

Main Methods:

• A prospective study included 18 patients with significant IPP (>5 mm) due to median lobe hyperplasia.
• Patients underwent PAE using trisacryl microspheres (30-500 μm).
• IPP was measured via MRI before and 3 months after PAE; IPSS and other clinical outcomes were assessed at 3 months.

Main Results:

• PAE significantly reduced IPP from 1.57 cm to 1.30 cm (p=0.0005) without complications.
• Significant improvements were observed in IPSS, quality of life (QoL), prostate-specific antigen (PSA), and prostate volume (PV).
• Maximum urinary flow rate (Qmax) increased significantly, while the International Index of Erectile Function (IIEF) showed no significant change. A positive correlation was found between IPP reduction and IPSS improvement (r=0.636, p=0.0045).

Conclusions:

• PAE is effective in reducing significant IPP in patients with median lobe hyperplasia.
• PAE leads to substantial symptomatic improvement in LUTS.
• The degree of IPP reduction is positively correlated with the extent of symptomatic improvement after PAE.