Presented by: Gabriel Alejandro Molineros Mayorga MD
Hadassah Ein KErem

Introduction

Patients with a permanent urinary catheter due to urinary retention caused by an enlarged prostate were previously treated with open or endoscopic prostatectomy if conservative treatment failed or if there was kidney damage during the retention episode.

Prostate artery embolization (PAE) has emerged as a less invasive alternative for weaning urinary catheters in patients with underlying prostate conditions. This study aims to evaluate the effectiveness and safety of PAE in catheter weaning, as well as the incidence of post-procedure complications.

Materials

A retrospective analysis was conducted on 70 patients who underwent PAE at our institution. Among them, 18 patients had indwelling urinary catheters. Patient demographics, including age and comorbidities, were recorded. The prostate size was measured before and after the procedure. Follow-up duration after PAE was documented. The primary outcome was the successful weaning of catheters. Complications were assessed using the Clavien Dindo classification system.

Results

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Out of the 70 patients who underwent PAE, 18 had indwelling urinary catheters. The mean age of the patients was 75.22 years (SD: 10.14). The mean prostate size was 155 grams (SD: 74.23). The average follow-up duration after the procedure was 3 months (SD: 5.8). A total of 17 patients successfully weaned from their catheters.

Complications: The reported complications after PAE were as follows:

Fever: Two patients experienced post-procedure fever (Clavien Dindo classification I).

Pain requiring admission to the ward: One patient reported post-procedure pain that necessitated hospitalization (Clavien Dindo classification I).

Temporary acute renal failure: One patient experienced temporary acute renal failure, which resolved within one week (Clavien Dindo classification IVa).

Uroflowmetric values measured after the procedure were:

QMAX (Maximum Flow Rate): The mean QMAX observed was 12.86 ml/sec.

PVR (Post-void Residual): The mean PVR was 145 cc.

Voided Volume: The mean voided volume was 157.29 cc.

Complications: The reported complications after PAE were as follows:

Fever: Two patients experienced post-procedure fever (Clavien Dindo classification I).

Pain requiring admission to the ward: One patient reported post-procedure pain that necessitated hospitalization (Clavien Dindo classification I).

Temporary acute renal failure: One patient experienced temporary acute renal failure, which resolved within one week (Clavien Dindo classification IVa).

Conclusion

The findings demonstrate that PAE can effectively facilitate catheter weaning in patients with indwelling urinary catheters. The success rate of catheter weaning was significant, with 17 out of 18 patients achieving this outcome. Although complications were observed, they were generally low in severity and manageable.

Prostate artery embolization shows promise as a valuable approach for catheter weaning in patients with indwelling urinary catheters. The high success rate in discontinuing catheterization and the low reported complications observed in this study present this procedure as a potential option for catheter weaning in patients with indwelling urinary catheters. Further research with larger sample sizes and longer follow-up periods is recommended to confirm these findings and assess the long-term efficacy and safety of PAE.

Funding

N/A

Lead Authors

Allan Bloom, MD.
Hadassah Ein Kerem