Effect of Prostate Artery Embolization on Erectile Function – A Single Center Experience of 167 Patients

Abstract

ABSTRACT Background Prostate artery embolization (PAE) is an emerging therapy for lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH). Aim This retrospective study was conducted to assess the effect of prostate artery embolization (PAE) on erectile function in a cohort of patients with LUTS attributable to BPH at 3-months after the procedure. Methods A retrospective review was performed on 167 patients who underwent PAE. Data collected included Sexual Health Inventory in Men (SHIM) scores at 3, 6, and 12 months post-PAE, in conjunction with the International Prostate Symptom Scores (IPSS), Quality of Life (QoL) scores, and prostate volumes. Primary outcome was erectile function as assessed by SHIM scores at 3 months after PAE. An analysis was performed to identify patients with a ±5-point SHIM change to group them according to this minimum clinically significant difference in erectile function. Adverse events were recorded using the Clavien-Dindo (CD) classification. Outcomes At 3 months following PAE, median IPSS decreased by 16.0 [IQR, 9.0–22.0] points, median QOL decreased by 4.0 [IQR, 2.0–5.0] points, and median prostate volume decreased by 33 g [IQR, 14–55]. Results Median SHIM score was 17.0 [IQR, 12.0–22.0] at baseline, 18.0 [IQR, 14.0–23.0] at 3 months [P = .031], 19.0 [IQR, 14.5–21.5] at 6 months [P = .106] and 20 [IQR, 16.0–24.0] at 12 months [P = .010] following PAE. In patients with no erectile dysfunction (ED) at baseline, 21% (n = 9) reported some degree of decline in erectile function post-PAE. However, 38% (n = 40) of patients who presented with mild-to-moderate ED reported improvement in their erectile function 3 months following PAE. Overall, the changes in baseline SHIM score were relatively small; 82% (n = 137) of patients did not have more than 5 points of change in their SHIM scores at 3 months following PAE. Clinical Implications Our findings suggest PAE has no adverse impact on erectile function for most patients. Strengths & Limitations The study was performed at a single center with 1 operator’s experience, and is retrospective with no control group. Conclusion Findings suggest that prostate artery embolization has no adverse effect on erectile function in the majority of patients with LUTS attributable to BPH at 3 months after the procedure.