prostate artery embolization (pae) for lower urinary tract symptoms (luts) due to benign prostatic hyperplasia (bph)

Conditions: Benign Prostatic Hyperplasia

Summary: this is a investigator-initiated evaluation of the safety and efficacy of treating benign prostatic hyperplasia (bph) by prostatic artery embolization.

this is a investigator-initiated evaluation of the safety and efficacy of treating benign prostatic hyperplasia (bph) by prostatic artery embolization.

Eligibility criteria:
inclusion criteria: inclusion criteria: * male, 45 years or older * diagnosis of lower urinary tract symptoms from benign prostatic hyperplasia refractory to medical therapy for at least 6 months. * ipss score at initial evaluation should be greater than 12, and uroflowmetry (qmax) of \<15ml/s (milliliters per second). * all prostate volumes will be \> 40gm * psa which meets one of the following criteria:baseline psa ≤ 2.5ng/ml, baseline psa \> 2.5 ng/ml and ≤ 10 ng/ml and free psa ≥ 25% of total psa (no biopsy required);baseline psa \> 2.5 ng/ml and ≤ 10 ng/ml and free psa \ 10 ng/ml and negative prostate biopsy result (minimum of 12 core biopsy) within 12 months;negative prostate biopsy (minimum 12 cores within 12 months) if abnormal digital rectal examination. exclusion criteria: * patients with active urinary tract infections or recurrent urinary tract infections (\> 2/year), prostatitis, or interstitial cystitis. * cases of biopsy proven prostate, bladder, or urethral cancer. * patients on long-term narcotic analgesia, androgen therapy, or gnrh (gonadotropin-releasing hormone) analogue therapy who are unwilling to stop therapy for 2 months prior to the study. * use of anithistamines, anti-convulsants, and antispasmodics within one week of treatment unless they have been treated with the same drug (at the same dosage) for at least 6 months and has an associated stable voiding pattern. * patients who are classified as new york heart association class iii (moderate), or higher, have cardiac arrhythmias, have uncontrolled diabetes, or are known to be immunosuppressed. * hypersensitivity reactions to contrast material not manageable with prophylaxis. * patients with glomerular filtration rates less than 40 who are not already on dialysis * prostate volume \<40 ml * patients with bilateral internal iliac arterial occlusion * patients with causes of bladder obstruction not due to bph (eg urethral stricture, bladder neck contraction, etc) * patients with neurogenic or bladder atonia * prior prostatectomy * cystolithiasis within the last 3 months * patients interested in future fertility * patients with a life expectancy less than 1 year * patients where embolization is not possible distal to collateral vessels feeding non-prostatic tissue * patients with major neurologic illnesses which could have symptoms that may be similar to or confused for bph (eg parkinson's disease, multiple sclerosis, shy-drager syndrome, spinal cord injury, etc.). * patients with urethral stents * patients who have undergone prior rectal surgery other than hemorrhoidectomy or pelvic irradiation. * patients who have started or changed their dosage of alpha blockers or 5-alpha reductase inhibitors in the month prior to pae

Keywords: therapeutic embolization prostatic artery embolization