Prostatic artery embolisation in New Zealand: audit of local cases

Objectives Prostate artery embolization (PAE) is performed in small numbers in New Zealand, but its global adoption is increasing. The USANZ position statement has shifted from advising that it 'should not be performed outside of clinical trials' to stating that it 'must be done with proper patient selection and adequate informed consent. However, no published local data is available on its outcomes. Our aim was to assess the safety and efficacy of prostate artery embolization in the New Zealand setting. Patients and method All cases of prostate artery embolisation that were performed at Auckland City Hospital were identified and records analyzed retrospectively. A total of 25 patients were identified. Median age was 70, median prostate size was 161cc. The primary endpoints of this study were safety, feasibility and efficacy. ● Safety was measured by adverse events ● Feasibility was defined by technical success ● Efficacy was defined by outcomes: ● Indication of prostatic bleeding: successful discharge from hospital without significant haematuria and further acute hospital presentations. ● Indication of lower urinary tract symptoms (LUTS): further procedures for LUTS Results 19 patients received PAE for LUTS, and 6 for prostatic bleeding. 97% were technically successful. There were no complications of Clavien-Dindo grade III or above. 83% of patients were day-stays or discharged day 1 post-procedurally. The short term efficacy of PAE for LUTS was 83% at 12 months, longer term efficacy dropping to 58% at 36 months. The short term efficacy of PAE for prostatic bleeding was 100%, longer term efficacy was 60%, with 3/5 patients not requiring any further hospitalisation for haematuria. The 2 patients who required further hospitalisation were successfully treated with ward based measures and did not require further invasive intervention. Conclusion PAE is a technically feasible and safe procedure. It is effective in the setting of prostatic bleeding. PAE for LUTS caused by benign prostatic hypertrophy (BPH) shows good short-term efficacy up to 12 months, but medium-term symptom recurrence is significantly higher than previously reported in the literature. This is likely confounded by the larger prostate sizes.