Estimation of efficacy of selective arterial embolization in patients with benign prostatic hyperplasia and high operation risk
Objective. To improve the results of surgical rehabilitation of patients with benign prostatic hyperplasia (BPH) and high operative risk, substantiating a differentiated approach for application of selective arterial embolization (SАЕ) and monopolar transurethral prostatic resection (ТUPR).
Маterials and methods. The efficacy and safety of a prostatic SАЕ performance, as a method of treatment of the lower urinary ways in patients with benign prostatic hyperplasia (BPH) and high operative risk, comparing with ТUPR, was investigated in the analysis way. The analysis was based on systematic studying of functional results and complications in 33 patients of the main group, to whom a SАЕ was performed and in 39 patients of a comparative group, to whom a ТUPR was done.
Results. The patients, to whom SАЕ was performed, did not have operative trauma, they have got a low risk of postoperative morbidity occurrence, as well as a shorter postoperative period and the indices improved: the International Prostatic Symptoms Scales (IPSS) - by 47.8%, the scales for the quality of life estimation (QoL) - by 53.3%, of maximal voluminous of the urine flow (Qmax) - by 58.4% on background of the prostatic volume reduction by 28.6% and the residual urine volume by 55.3% during 24 mo of follow-up, confirming the thesis, that prostatic SАЕ constitutes an effective and safe method of miniinvasive treatment of BPH in patients with high operative risk. After monopolar ТUPR the results were similar: the IPSS indices improvement - by 50%, QoL - by 65.1%, Qmax - by 59.2%, the prostatic volume reduction - by 31.6% and of the residual urine volume - by 64.6%, but this method was accompanied by statistically enhanced morbidity rate, degrading the perioperative safety level.
Conclusion. The investigation results have witnessed, that SАЕ constitutes an effective and secure method of treatment in patients with BPH and high operative risk, giving equal result with ТUPR, but with less risk for postoperative morbidity occurrence. SAE may constitute a method of choice in elderly patients with severe concurrent diseases, who owe contraindications for a standard operative intervention or rejected its performance due to other causes.
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