Abstract No. 97 Adjunctive Coil Embolization After Prostatic Artery Embolization is Safe and Results in Greater Prostate Volume Shrinkage

Prostate artery recanalization after prostatic artery embolization (PAE) is suggested as one of the major etiologies for recurrence of symptoms after PAE. We reasoned that coil embolization of main prostatic artery after particle embolization reduces the chance of prostate regrowth and aimed to study safety and efficacy of coil embolization of main prostatic artery after particle prostatic artery embolization (coil-out technique). A retrospective single-center analysis of 163 patients from July 2020-Sep 2023, who underwent successful bilateral PAEs was performed. The coil-out technique was started at ∼1 yr after initiation of this practice. Only patients with complete imaging follow up at more than 3 months after PAE who did not undergo prostatectomy after PAE were included (n=27, 15 in coil-out group). Clinical outcomes, adverse events and repeat embolization were collected and compared between the coil-out technique and standard PAE. Mean (SD) patient age and prostate volume were 74 (8) years and 141 (99) milliliters. Age and the baseline prostate volumes were not different between the coil and no-coil groups (p >0.1). At 1 month, international prostate symptoms scores (IPSS) decreased from 20 to 6 and quality of life improved from 5 to 1 (p< 0.001). Success for resolution of hematuria was 100%, and for resolution of retention was 96%. Prostate volume shrinkage varied between 14% to 67%. Volume percentage shrinkage was statistically greater in the coil-out group (44% vs. 33%, p=0.046). One patient from each group was admitted for 2 days after PAE for pain control. Post embolization syndrome was experienced between 3-10 days after procedure without difference between groups. Follow up erectile function was no different. Hematuria or hematospermia were similar (p=0.1). At median follow-up of 6 months (range 1-33 months), one patient in the no coil group underwent repeat PAE, versus no patients in the coil-out group. The coil-out technique has a similar safety profile to the standard PAE technique. The volumetric analysis suggests that shrinkage is more with the coil-out technique and may reduce the recurrence rate after PAE.