Introduction: To compare long-term results for gross hematuria improvement in =80mL versus >80mL prostate gland volume (PGV) cohorts treated with spherical particle prostatic artery embolization (PAE).
Methods: 106 patients with prostate-related gross episodic hematuria (EH) or severe hematuria (SH)(requiring admission and bladder irrigation) who underwent technically successful PAE with spherical particles from December 2013 through September 2021 were retrospectively reviewed. Patients with active urine infection, urinary calculi, or urological cancers were not included. Patients were divided into cohorts of PGV =80mL or >80mL and followed at 1, 3, 6, 12, 24, 36, and 48 months after PAE. Pre- and post-PAE blood transfusions and hematuria-related healthcare visits were tabulated.
Results: 17 patients had PGV =80mL (mean=60mL±11mL, age=76.3±9.2y, Charlson comorbidity index (CCI)=4.4±2.2); all had EH only. 89 patients had PGV >80mL (mean=189mL±107mL, age=73.0±8.5y, CCI=3.9±1.8); 73 of these presented with EH and 16 with SH. After PAE, both =80mL and >80mL cohorts had dramatic reduction in gross hematuria, sustained through 48 months. Both cohorts had similar treatment success and had similar proportions of patients with clear urine, residual/recurrent EH, or residual/recurrent SH throughout (Table). For all patients, 41 units of blood were transfused prior to PAE and 3 units transfused after, all within 48 hours of PAE in 2 patients. There were 36 healthcare visits for hematuria prior to PAE, with 7 post-PAE hematuria-related visits as of latest follow-up (mean=1130±631 days). No relationships between post-PAE transfusions or hematuria-related visits and PGV were observed.
Conclusions: Severe hematuria only presented in patients with PGV >80mL. Improvements in prostate-related EH and SH after PAE were substantial and sustained through 4 years, with similar trends observed in both =80mL and >80mL patient cohorts. PAE is an effective treatment for prostate-related gross hematuria, regardless of gland size.