Skip to main content
Log in

Improvements in Irritative Versus Obstructive Symptoms of the International Prostate Symptom Score After Prostatic Artery Embolization in 174 Patients, in a Single Center

  • Clinical Investigation
  • Embolisation (arterial)
  • Published:
CardioVascular and Interventional Radiology Aims and scope Submit manuscript

Abstract

Aim

The aim of this study is to compare the improvements in irritative versus obstructive symptoms of the International Prostate Symptom Score (IPSS) after prostatic artery embolization (PAE) in patients with benign prostatic hyperplasia (BPH).

Materials and Methods

Between 2010 and 2018, 186 patients underwent PAE in a single center and 174 patients were retrospectively selected. The inclusion criteria were symptoms due to BPH, refractory to pharmacological treatment and IPSS ≥ 8. The mean age of the patients was 63.7 ± 7.2 years, the mean prostate volume 89.5 ± 42.5 cm3, and the mean IPSS 19.0 ± 6.2 points. Patient data were reviewed at baseline, 3, 12 and 24 months and compared using the ANOVA mixed models and the Tukey’s multiple comparison test.

Results

Obstructive subscores dropped more significantly than irritative subscores (p < 0.0001). The mean decrease in each IPSS item was frequency 2.4 (83%); urgency 0.8 (87%); nocturia 1.3 (49%); incomplete emptying 2.6 (83%); intermittency 2.3 (91%); weak stream 2.9 (82%); straining 1.6 (91%). The area under the curve for baseline obstructive scores was 0.7 (p = 0.006) and 0.59 (p = 0.182) for irritative scores. The most common BPH clinical manifestations include irritative and/or obstructive symptoms, the latter usually more prevalent. The IPSS drop observed after PAE suggests that it acts predominantly over obstructive symptoms (p < 0.0001).

Conclusion

Although a predominant improvement in obstructive symptoms may be observed after PAE, nocturia complaints may require special attention. The severity of baseline obstructive symptoms may significantly predict clinical outcomes.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Barry MJ, Fowler FJ Jr, O’Leary MP, Bruskewitz RC, Holtgrewe HL, Mebust WK, et al. The American Urological Association symptom index for benign prostatic hyperplasia. J Urol. 1992;148:1549–53.

    Article  CAS  Google Scholar 

  2. Liao C-H, Kuo H-C. Measurement of international prostate symptom score subscores. Incont Pelvic Floor Dysfunc. 2010;4(2):39–43.

    Google Scholar 

  3. de la Rosette JJ, Witjes WP, Schäfer W, Abrams P, Donovan JL, Peters TJ, Millard RJ, Frimodt-Møller C, Kalomiris P. Relationships between lower urinary tract symptoms and bladder outlet obstruction: results from the ICS-”BPH” study. Neurourol Urodyn. 1998;17(2):99–108.

    Article  Google Scholar 

  4. Cockett AT, Aso Y, Denis L et al. (1993) Recommendations of the international consensus committee concerning: 1. Prostate Symptom Score (I-PSS) and quality of life assessment, 2. Diagnostic work-up of patients presenting with symptoms suggestive of prostatism, 3. Standardization of the evaluation of treatment modalities, 4. BPH treatment recommendations. In: Cockett ATK, Khoury S, Aso Y, Chatelain C, Denis L, Griffiths K, Murphy G (eds) The 2nd International consultation on benign prostatic hyperplasia (BPH), Paris, June 27–30, 1993, Proceedings. Scientific Communication International Ltd, Jersey, Channel Islands, pp 553–564.

  5. Oelke M, Baard J, Wijkstra H, de la Rosette JJ, Jonas U, Höfner K. Age and bladder outlet obstruction are independently associated with detrusor overactivity in patients with benign prostatic hyperplasia. Eur Urol. 2008;54(2):419–26.

    Article  Google Scholar 

  6. Madersbacher S, Pycha A, Klingler CH, Schatzl G, Marberger M. The International Prostate Symptom score in both sexes: a urodynamics-based comparison. Neurourol Urodyn. 1999;18(3):173–82.

    Article  CAS  Google Scholar 

  7. Uflacker A, Haskal ZJ, Bilhim T, Patrie J, Huber T, Pisco JM. Meta-analysis of prostatic artery embolization for benign prostatic hyperplasia. J Vasc Interv Radiol. 2016;27(11):1686–97.

    Article  Google Scholar 

  8. Ray AF, Powell J, Speakman MJ, Longford NT, DasGupta R, Bryant T, Modi S, Dyer J, Harris M, Carolan-Rees G, Hacking N. Efficacy and safety of prostate artery embolization for benign prostatic hyperplasia: an observational study and propensity-matched comparison with transurethral resection of the prostate (the UK-ROPE study). BJU Int. 2018;122(2):270–82. https://doi.org/10.1111/bju.14249Epub 2018 May 6.

    Article  PubMed  Google Scholar 

  9. de Assis AM, Moreira AM, de Paula Rodrigues VC, Yoshinaga EM, Antunes AA, Harward SH, Srougi M, Carnevale FC. Prostatic artery embolization for treatment of benign prostatic hyperplasia in patients with prostates > 90 g: a prospective single-center study. J Vasc Interv Radiol. 2015;26(1):87–93.

    Article  Google Scholar 

  10. Agresti A. Categorical data analysis. New York: Wiley; 1990. p. 558p.

    Google Scholar 

  11. Conover WJ. Practical nonparametric statistics. New York: Wiley; 1980.

    Google Scholar 

  12. Neter J, Wasserman W, Kutner MH. Applied linear statistical models. 3rd ed. Illinois: Homewood; 1990.

    Google Scholar 

  13. Winer BJ. Statistical principles in experimental designs. 2ª ed. New York: McGraw-Hill; 1971. p. 907p.

    Google Scholar 

  14. Malling B, Røder MA, Brasso K, Forman J, Taudorf M, Lönn L. Prostate artery embolisation for benign prostatic hyperplasia: a systematic review and meta-analysis. Eur Radiol. 2019;29(1):287–98.

    Article  CAS  Google Scholar 

  15. Kuang M, Vu A, Athreya S. A systematic review of prostatic artery embolization in the treatment of symptomatic benign prostatic hyperplasia. Cardiovasc Intervent Radiol. 2017;40(5):655–63.

    Article  Google Scholar 

  16. Pisco JM, Rio TH, Campos PL, Bilhim T, Duarte M, Fernandes L, Pereira J, Oliveira A. Embolisation of prostatic arteries as treatment of moderate to severe lower urinary symptoms (LUTS) secondary to benign hyperplasia: results of short- and mid-term follow-up. Eur Radiol. 2013;23(9):2561–72.

    Article  Google Scholar 

  17. Wang MQ, Wang Y, Yan JY, Yuan K, Zhang GD, Duan F, Li K. Prostatic artery embolisation for the treatment of symptomatic benign prostatic hyperplasia in men ≥ 75 years: a prospective single-center study. World J Urol. 2016;34:1275–83.

    Article  Google Scholar 

  18. Maclean D, Kong M, Lim J, Modi S, Harris M, Bryant T, Hacking N. Does prostate artery embolization (PAE) improve obstructive symptoms, irritative symptoms, or both? Cardiovasc Interv Radiol. 2019. https://doi.org/10.1007/s00270-019-02298-3.

    Article  Google Scholar 

  19. Dmochowski RR. Bladder outlet obstruction: etiology and evaluation. Rev Urol. 2005;7(Suppl 6):S3–13.

    PubMed  PubMed Central  Google Scholar 

  20. Sun F, Sánchez FM, Crisóstomo V, Lima JR, Luis L, García-Mar-tínez V, López-Sánchez C, Usón J, Maynar M. Benign prostatic hyperplasia: transcatheter arterial embolization as potential treatment-preliminary study in pigs. Radiology. 2008;246(3):783–9.

    Article  Google Scholar 

  21. Rosier P. Contemporary diagnosis of lower urinary tract dysfunction [version 1; peer review: 2 approved]. F1000Research. 2019;8(1000):644.

    Article  Google Scholar 

  22. McVary KT, Roehrborn CG, Avins AL, Barry MJ, Bruskewitz RC, Donnell RF, Foster HE Jr, Gonzalez CM, Kaplan SA, Penson DF, Ulchaker JC, Wei JT. Update on AUA guideline on the management of benign prostatic hyperplasia. J Urol. 2011;185(5):1793–803.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Airton Mota Moreira.

Ethics declarations

Conflict of interest

All authors declare that they have no conflict of interest.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Moreira, A.M., de Assis, A.M., Carnevale, F.C. et al. Improvements in Irritative Versus Obstructive Symptoms of the International Prostate Symptom Score After Prostatic Artery Embolization in 174 Patients, in a Single Center. Cardiovasc Intervent Radiol 43, 613–619 (2020). https://doi.org/10.1007/s00270-019-02398-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00270-019-02398-0

Keywords

Navigation