Prospective study of percutaneous transarterial embolization in the treatment of benign prostatic hyperplasia

• Grant number: 13/17075-3
• Support Opportunities: Regular Research Grants
• Start date: November 01, 2014
• End date: June 30, 2016
• Field of knowledge: Health Sciences - Medicine - Surgery
• Principal Investigator: Marcone Lima Sobreira
• Grantee: Marcone Lima Sobreira
• Host Institution: Faculdade de Medicina (FMB). Universidade Estadual Paulista (UNESP). Campus de Botucatu. Botucatu , SP, Brazil
• Associated researchers: Paulo Roberto Kawano ; Sergio Marrone Ribeiro

Abstract

The Benign Prostatic Hyperplasia (BPH) is a common disease in elderly men and their care increase as the population ages. About 25% of men over 40 years and 90% of those aged over 80 years will present some symptoms related to lower urinary tract due to BPH Currently, treatment options include drug therapy (conservative) and surgeries, which are indicated in the failure of pharmacological treatment or in the presence of complications. In general, the surgical treatment gives good results, especially in minimally invasive forms, such as transurethral resection of the prostate (TURP), still considered reference therapy, with improvement in about 70% of cases. For bigger glands, open prostatectomy, whether by transvesical access (PTV) or the Millin's retropubic via, is an excellent treatment option. However, considering the high prevalence of BPH in elderly patients, often suffering from severe comorbidities, surgery in this age group may have restrictions. In this scenario, Percutaneous transarterial embolization of the Prostate (PTEP) emerges as an alternative to classical surgical therapy, particularly in patients who did not respond to drug therapy and surgery is contraindicated, as for prohibitive risk Objectives : In this project, we intend to evaluate clinically the effects of microspheres PTEP with this group of patients treated at Botucatu School of Medicine. Methods: The project must be aprovved by the CEP. There will be recruited 10 consecutive patients that had been followed at Prostatic Disease ambulatory of Urology Service at FMB-UNESP and with definitive diagnostic of BPH. The sample will be of convenience. The patients will be evaluated about the cardiac risk by a cardiologist, using the AHA criteria. The inclusion criteria will be: patients with Benign Prostatic Hyperplasia with surgery indication, without clinical condition to be operated by standard treatment (high cardiac risk by the AHA protocol), that didn't answered to the classic drug terapy e that are agree with the free and informed consent form. The exclusion criteria will be: patient with less than 40 years old; that had been submitted to a surgery (endoscopic or open) previously for treatment of BPH (recurrence); with prostate neoplasia: exclusion by the prostate specific antigen (PSA); touch and biopsy, when necessary; that are not agree with the treatment in question; that have others concomitant urologic diseases, as urethra stenosis, neurogenic bladder, kidney chronic insufficience, etc; that have contraindications to the proposed therapeutic procedure, as contrast allergy, kidney chronic insufficience and access difficulty by the femoral artery.In short, the proposed procedure will be superseletive catheterization of the prostatic artery and provoke prostate ischemia with the use of microespheres.The studied variables will be: evaluation of the life quality by the IPSS (Internation Prostatic Symptoms score); objective evaluation of the urinary flow; prostatic volume characterization, by ultrasound and magnetic resonance; and evaluation of the post-miccional residual volume. (AU)