Coil-out: comparing outcomes after prostate artery embolization with and without endovascular coiling

Area of Science:

• Urology
• Interventional Radiology
• Medical Device Technology

Background:

• Benign prostatic hyperplasia (BPH) is a common condition in aging men.
• Prostate artery embolization (PAE) is an emerging minimally invasive treatment for BPH.
• Adjunctive coiling in PAE is performed to potentially enhance particle retention.

Purpose of the Study:

• To compare post-procedural symptom score changes after PAE with and without adjunctive prostate artery coiling.
• To evaluate the efficacy of standard PAE versus coil-out PAE in improving lower urinary tract symptoms.

Main Methods:

• Retrospective analysis of 573 PAE procedures involving 317 patients (mean age 72.1 years).
• Comparison of International Prostate Symptom Score (IPSS), Quality of Life/Bother (QOL/Bother), and Sexual Health Inventory for Men (SHIM-IIEF V) scores at 1-5 and 9-15 months.
• Analysis of procedure and fluoroscopy times for both PAE techniques.

Main Results:

• The standard PAE group demonstrated significantly greater reduction in IPSS at 1-5 months (-12.2 vs. -9.9, p=0.018) and 9-15 months (-12.5 vs. -7.6, p=0.018).
• Greater QOL/Bother improvement was observed in the standard PAE group at 9-15 months (-2.8 vs. -1.8, p=0.014).
• Procedure times were longer for standard PAE (186 vs. 173 min; p=0.039), while fluoroscopy times were longer for coil-out PAE (48.3 vs. 44.8 min; p=0.014).

Conclusions:

• Particle embolization alone (standard PAE) appears more effective than adjunctive coil embolization for improving BPH symptoms.
• The findings suggest that adjunctive coiling may not offer additional benefits and could potentially impact symptom improvement.
• Further research with longer follow-up is warranted to confirm these findings.