Impact on Sexual Function of Protective Coil Embolization of Penile Collaterals During Prostatic Artery Embolization

This study aims to evaluate the erectile and ejaculatory function of patients undergoing prostate artery embolization with coil embolization of penile collaterals (cPAE) compared to traditional PAE (tPAE) for treating lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH).

878 patients who underwent PAE for LUTS secondary to BPH at a single institution from September 2014 to September 2022 were assessed. 828 (94%) underwent tPAE, and 50 (6%) underwent cPAE. Sexual Health Inventory for Men (SHIM) and Ejaculatory Function Questionnaire (EJQ) scores were reviewed pre-procedure and at subsequent follow-ups.

In tPAE, the median (interquartile range (IQR), p-value compared to baseline) SHIM scores were 19(14-24, p =  < 0.001), 19(13-18, p = 0.22), 19(16-23, p = 0.005), and 18(15-22, p = 0.52) at 3, 6, 12, and 24 months, respectively, from a baseline of 17(10-21). In cPAE, median-(IQR, p-value compared to baseline) SHIM scores were 16(6.5-22.5, p = 0.03), 13(6.8-16.3, p = 0.04), 8.5(5-1.5, p = 0.46), and 18(15-18, p = 1) at 3, 6, 12, and 24 months, respectively, from baseline of 13 (8-20). There was no significant difference in SHIM score change from baseline between cPAE and tPAE groups at 3(p = 0.60), 6(p = 0.31), 12(p = 0.09), and 24 months(p = 1) post-PAE. In tPAE, median(IQR, p-value compared to baseline)-EJQ scores were 16(13-18, p = 0.42), 16(13-18, p = 0.22), 17(12-19, p = 0.09), and 16(12.5-19, p = 1) at 3, 6, 12, and 24 months, respectively, from baseline of 14 (11-18). In cPAE group, median EJQ scores were 14(10.5-20, p = 0.11), 18(17-18), 16.5(3.5-19.7, p = 1) at 3, 6, and 12 months, respectively, from baseline of 15(12-18). There was no significant difference in EJQ score change from baseline between cPAE and tPAE groups at 3(p = 0.26), 6(p = 0.38), and 12(p = 0.88) months.

Adjunct coil embolization of penile collaterals during PAE for preventing nontarget embolization has no adverse effect on erectile or ejaculatory function.