Impact of High Baseline Postvoid Residual Volume on Outcomes Following Prostatic Artery Embolization

Area of Science:

• Urology
• Interventional Radiology

Background:

• Benign prostatic hyperplasia (BPH) is a common condition causing lower urinary tract symptoms.
• Prostatic artery embolization (PAE) is an effective minimally invasive treatment for BPH.
• The durability of PAE outcomes requires further investigation, particularly concerning baseline patient factors.

Purpose of the Study:

• To assess the association between elevated baseline post-void residual (PVR) volume and the long-term durability of PAE.
• To identify predictors of PAE failure or reduced treatment longevity.

Main Methods:

• Retrospective analysis of 176 patients who underwent PAE between 2015 and 2023.
• Stratification of patients based on baseline PVR: ≥300 mL versus <300 mL.
• Primary outcome: composite of subsequent prostate surgery and/or indwelling urinary catheter placement.

Main Results:

• Patients with baseline PVR ≥300 mL had a significantly higher risk of the composite endpoint (38.7% vs. 11.3%; RR 3.43; p=0.0003).
• Improvements in International Prostate Symptom Score (IPSS) and Quality of Life (QoL) were similar between groups.
• Higher PVR group experienced comparable early symptom relief but increased risk of later interventions.

Conclusions:

• Elevated baseline PVR is associated with reduced durability of PAE.
• PAE offers similar early symptomatic improvement regardless of baseline PVR, but higher PVR predicts a greater need for re-intervention.
• Baseline PVR should be considered when counseling patients on PAE outcomes.