Central gland detachment following prostate artery embolization: incidence, risk factors and clinical outcomes

Central gland detachment (CGD) is a potential complication following prostate artery embolisation (PAE). There is limited information regarding its incidence, associated risk factors, and voiding and ejaculatory function after CGD.

Sixty-five consecutive patients undergoing PAE in a single institution were included in this retrospective cohort study. Baseline demographics, radiologic, procedural and clinical outcome data were gathered for all patients. CGD was diagnosed following clinical review and confirmed via cystoscopy or MRI as required.

Six out of 65 (9.2%) patients undergoing PAE developed CGD. Mean baseline prostate volume was 150 mL. CGD occurred more frequently among patients with prostate volume > 150 mL than among those with volume ≤ 150 mL (19.2% vs. 2.6%, p = 0.03). Embolisation was performed with particles < 300 μm in 11/65 cases; CGD incidence was numerically higher among patients treated with particles < 300 μm than with particles > 300 μm (27.3 vs. 5.6%, p = 0.056), although this association did not reach statistical significance. 4/6 patients required cystoscopic removal of sloughed tissue. After resolution of the acute CGD episode, mean International Prostate Symptoms Scores (IPSS) and quality of life due to urinary symptoms (QOL) scores improved from 22 to 2.3 and from 5.3 to 0.5 respectively. In those with preserved ejaculatory function at baseline, 3/4 CGD patients developed new retrograde ejaculation.

Central gland detachment is an uncommon but clinically significant complication of PAE. Severe prostatomegaly may be associated with CGD, and cases can occur despite use of medium-sized particles (> 300 μm). Long-term voiding outcomes are generally favourable, but new ejaculatory dysfunction can occur.