Prostatic Artery Embolisation in Fragile and Elderly Patients with Indwelling Bladder Catheter

Fragile patients with indwelling bladder catheter (IBC) represent a category at high risk of morbidity and overall quality of life decline. The goal for these patients is to remove the bladder catheter and avoid surgical stress, complications and long hospitalisation. Prostatic artery embolisation (PAE) has been developed as a minimally invasive procedure for the treatment of benign prostatic obstruction (BPO)-related lower urinary tract symptoms. We evaluated the results of PAE in patients unfit for surgery with IBC.

We retrospectively reviewed data on fragile patients unfit for surgery due to comorbidities with IBC secondary to BPO who underwent PAE in three centres. Our objective was to remove urinary catheter and maintain patients free from bladder catheter. We divided patients into two groups: Those with successful (Group A) or unsuccessful (Group B) procedure after 1 year.

A total of 74 patients with IBC receiving PAE were included. No PAE failure occurred due to tortuous or atherosclerotic vessels. After 1 year, 49 patients (66.20%) were without bladder catheter. We found no differences in age (75.30 vs 78.70), Charlson comorbidity index (6.00 vs 6.60), prostate volume (94.70 vs 94.70), hospital stay (1.90 vs 3.90 days), catheterisation time after the procedure (17.20 vs 20.80 days) or complication rate (11.20% vs 8.30%) between Groups A and B. One patient developed postembolisation partial penile necrosis, two had penile skin ischemia (conservatively managed), and four developed urinary tract infection following the procedure. The history of IBC was longer in Group B than in Group A (9.70 vs 6.20 months, p = 0.018). Multivariate logistic regression confirmed a significant reduction in the probability of unsuccessful procedure based on an increased postoperative catheterisation time (odds ratio = 0.91; 95% confidence interval: 0.83-0.99).

PAE is a minimally invasive surgical treatment for BPO. This procedure should be considered in elderly and fragile patients, based on its favourable safety profile. In our series, PAE was a safe procedure for patients with IBC affected by BPO. In our experience, the success of this treatment is correlated with postoperative catheterisation. Patient's selection and counselling are key for optimising the results.